Local delivery of antineoplastic particles in combination with systemic delivery of immunotherapeutic agents for the treatment of cancer

ABSTRACT

Disclosed are combination therapy methods useful for the therapeutic treatment of cancer by combining local administration of compositions containing antineoplastic particles, such as taxane particles, with systemic administration of compositions containing immunotherapeutic agents. Local administration methods include topical application, pulmonary administration, intratumoral injection, intraperitoneal injection, arid intracystic injection.

CROSS REFERENCE

This application is a Continuation of U.S. patent application Ser. No.17/333,629, filed May 28, 2021 which is a Continuation of U.S. patentapplication Ser. No. 16/834,155, filed Mar. 30, 2020 now U.S. patentSer. No. 11/058,639 issued Jul. 13, 2021, which is a Continuation ofInternational Application No. PCT/US2018/054156, filed on Oct. 3, 2018,which claims priority to U.S. Provisional Application No. 62/567,445,filed Oct. 3, 2017, all of which are incorporated by reference herein intheir entirety.

SUMMARY OF THE INVENTION

The present invention provides methods to treat cancer through the useof combined local and systemic therapies, i.e., local administration ofantineoplastic agent particles (chemotherapeutic particles), such astaxane particles, directly to a tumor as an adjuvant to systemicadministration of an immunotherapeutic agent.

In one aspect of the invention, disclosed is a method of treating cancerin a subject, the method comprising: (a) topically administering a firstcomposition comprising antineoplastic particles to the affected area ofa skin tumor of the subject and (b) systemically administering a secondcomposition comprising an immunotherapeutic agent to the subject,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns, andwherein steps (a) and (b) can be conducted in any order or at the sametime. In some embodiments, the skin tumor is a benign skin tumor, andwherein the subject has cancer in areas of the body other than in theskin. In other embodiments, the skin tumor is a skin malignancy(malignant skin tumor). In some embodiments, the subject has cancer inother areas of the body. In some embodiments, the antineoplasticparticles comprise taxane particles. In some embodiments, the taxaneparticles comprise paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof.

In another aspect of the invention, disclosed is a method of treatingcancer in a subject, the method comprising: (a) administering a firstcomposition comprising antineoplastic particles to the subject bypulmonary administration, and (b) systemically administering a secondcomposition comprising an immunotherapeutic agent to the subject,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns, whereinthe subject has a lung disease, and wherein steps (a) and (b) can beconducted in any order or at the same time. In some embodiments, thelung disease is non-cancerous, and wherein the subject has cancer inareas of the body other than in the lung. In some embodiments, thenon-cancerous lung disease is restrictive or obstructive lung disease.In other embodiments, the lung disease is cancerous. In someembodiments, the cancerous lung disease is a malignant tumor ormesothelioma. In some embodiments, the malignant tumor is a non-smallcell lung cancer tumor. In some embodiments, the subject has cancer inother areas of the body. In some embodiments, the antineoplasticparticles comprise taxane particles. In some embodiments, the taxaneparticles comprise paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof. In some embodiments, thepulmonary administration comprises nebulization and wherein thenebulizing results in pulmonary delivery to the subject of aerosoldroplets of the first composition. In some embodiments, theantineoplastic agent is detectable in lung tissue of the subject for atleast 4 days, or at least 14 days after administration of the firstcomposition.

In another aspect of the invention, disclosed is a method of treatingcancer in a subject, the method comprising: (a) administering a firstcomposition comprising antineoplastic particles directly into a solidtumor of the subject by intratumoral injection, and (b) systemicallyadministering a second composition comprising an immunotherapeutic agentto the subject, thereby treating the cancer, wherein the antineoplasticparticles have a mean particle size (number) of from 0.1 microns to 5microns, and wherein steps (a) and (b) can be conducted in any order orat the same time. In some embodiments, the solid tumor is a benigntumor, and wherein the subject has cancer elsewhere in the body. Inother embodiments, the solid tumor is a malignant tumor. In someembodiments, the malignant tumor comprises a sarcoma, a carcinoma, alymphoma, a breast tumor, a prostate tumor, a head and neck tumor, aglioblastoma, a bladder tumor, a pancreatic tumor, a liver tumor, anovarian tumor, a colorectal tumor, a skin tumor, a cutaneous metastasis,a lymphoid, and/or a gastrointestinal tumor. In some embodiments, thesubject has cancer in other areas of the body. In some embodiments, theantineoplastic particles comprise taxane particles. In some embodiments,the taxane particles comprise paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof.

In another aspect of the invention, disclosed is a method of treatingcancer in a subject, the method comprising: (a) administering a firstcomposition comprising antineoplastic particles to an intraperitonealorgan tumor of the subject by intraperitoneal injection, and (b)systemically administering a second composition comprising animmunotherapeutic agent to the subject, thereby treating the cancer,wherein the antineoplastic particles have a mean particle size (number)of from 0.1 microns to 5 microns, and wherein steps (a) and (b) can beconducted in any order or at the same time. In some embodiments, thetumor is benign and wherein the subject has cancer elsewhere in thebody. In other embodiments, the tumor is malignant. In some embodiments,the subject has cancer in other areas of the body. In some embodiments,the tumor is an ovarian tumor. In some embodiments, the antineoplasticparticles comprise taxane particles. In some embodiments, the taxaneparticles comprise paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof.

In various embodiments of the invention, the immunotherapeutic agent ofthe second composition is a monoclonal antibody, a cancer vaccine, anon-specific immunotherapeutic agent, a cytokine, interferon,interleukin, a colony stimulating factor, a checkpoint inhibitor, animmune modulator, an adoptive cell transfer agent, a T-cell therapeuticagent, a cellular therapeutic agent, an oncolytic virus therapeuticagent, BCG, and/or an adjuvant immunotherapeutic agent. In someembodiments, the systemic administration of the second composition isintravenous (IV) injection or oral delivery. In some embodiments, thefirst composition is administered at least one day prior to theadministration of the second composition. In other embodiments, thesecond composition is administered at least one day prior to theadministration of the first composition. In still other embodiments, thefirst composition and the second composition are administered on thesame day.

In various embodiments, the amount of antineoplastic particles in thefirst composition and the amount of immunotherapeutic agent in thesecond composition are at effective amounts to treat the cancer in thesubject and optionally to treat the tumor of the subject. In variousembodiments, the local administration of the first compositionstimulates an immunological response to the immunotherapeutic agent inthe subject after the systemic administration of the second composition.

In another aspect of the invention, disclosed is a kit comprising: (a) afirst composition comprising taxane particles, wherein the taxaneparticles have a mean particle size (number) of from 0.1 microns to 5microns, (b) a second composition comprising an immunotherapeutic agent,and (c) instructions for (i) administering the first composition locallyto a subject, and (ii) administering the second composition systemicallyto the subject.

In another aspect of the invention, disclosed is a method of treatingcancer in a subject, the method comprising: (a) administering a firstcomposition comprising antineoplastic particles directly into a cyst ofthe subject by intracystic injection, and (b) systemically administeringa second composition comprising an immunotherapeutic agent to thesubject, thereby treating the cancer, wherein the antineoplasticparticles have a mean particle size (number) of from 0.1 microns to 5microns, and wherein steps (a) and (b) can be conducted in any order orat the same time. In various embodiments, the antineoplastic particleshave a mean particle size (number) of from 0.1 microns to 1.5 microns.In some embodiments, the cyst is an epithelial cyst. In someembodiments, the cyst is a benign cyst, and the subject has cancerelsewhere in the body. In some embodiments, the cyst is a malignantcyst. In some embodiments, the malignant cyst is the only cancer in thebody of the subject. In other embodiments, the subject has a malignantcyst and cancer in other areas of the body. In some embodiments, thecyst is a pancreatic cyst. In other embodiments, the antineoplasticagent is a taxane and the antineoplastic particles are taxane particles.The taxane particles can include pharmaceutically acceptable salts ofthe taxane particles. In some embodiments, the taxane particles arepaclitaxel particles, docetaxel particles, cabazitaxel particles, orcombinations thereof. In some embodiments, the local administration ofthe first composition stimulates an immunological response to theimmunotherapeutic agent in the subject after the systemic administrationof the second composition.

In another aspect of the invention, disclosed is a method of treatingcancer in a subject, the method comprising: (a) administering a firstcomposition comprising antineoplastic particles to a tumor located in abody cavity of the subject by injection into the body cavity, and (b)systemically administering a second composition comprising animmunotherapeutic agent to the subject, thereby treating the cancer,wherein the antineoplastic particles have a mean particle size (number)of from 0.1 microns to 5 microns, and wherein steps (a) and (b) can beconducted in any order or at the same time. In various embodiments, theantineoplastic particles have a mean particle size (number) of from 0.1microns to 1.5 microns. In some embodiments, the tumor is a benigntumor, and the subject has cancer elsewhere in the body. In someembodiments, the tumor is a malignant tumor. In some embodiments, themalignant tumor is the only cancer in the body of the subject. In otherembodiments, the subject has a malignant tumor and cancer in other areasof the body. In other embodiments, the antineoplastic agent is a taxaneand the antineoplastic particles are taxane particles. The taxaneparticles can include pharmaceutically acceptable salts of the taxaneparticles. In some embodiments, the taxane particles are paclitaxelparticles, docetaxel particles, cabazitaxel particles, or combinationsthereof. In some embodiments, the local administration of the firstcomposition stimulates an immunological response to theimmunotherapeutic agent in the subject after the systemic administrationof the second composition.

Disclosed in the context of the present invention are the followingembodiments 1 to 133:

-   -   Embodiment 1 is a method of treating cancer in a subject, the        method comprising: (a) topically administering a first        composition comprising antineoplastic particles to the affected        area of a skin tumor of the subject and (b) systemically        administering a second composition comprising an        immunotherapeutic agent to the subject, thereby treating the        cancer, wherein the antineoplastic particles have a mean        particle size (number) of from 0.1 microns to 5 microns, and        wherein steps (a) and (b) can be conducted in any order or at        the same time.    -   Embodiment 2 is the method of embodiment 1, wherein the skin        tumor is a benign skin tumor, and wherein the subject has cancer        in areas of the body other than in the skin.    -   Embodiment 3 is the method of embodiment 2, wherein the benign        skin tumor is actinic keratosis.    -   Embodiment 4 is the method of embodiment 1, wherein the skin        tumor is a skin malignancy (malignant skin tumor).    -   Embodiment 5 is the method of embodiment 4, wherein the skin        malignancy comprises a skin cancer.    -   Embodiment 6 is the method of embodiment 5, wherein the skin        cancer comprises a melanoma, a basal cell carcinoma, or a        squamous cell carcinoma.    -   Embodiment 7 is the method of embodiment 6, wherein the skin        malignancy comprises a cutaneous metastasis.    -   Embodiment 8 is the method of embodiment 7, wherein the        cutaneous metastasis is from lung cancer, breast cancer, colon        cancer, oral cancer, ovarian cancer, kidney cancer, esophageal        cancer, stomach cancer, liver cancer, and/or Kaposi's sarcoma.    -   Embodiment 9 is the method of any one of embodiments 4 to 8,        wherein the subject has cancer in other areas of the body.    -   Embodiment 10 is the method of any one of embodiments 1 to 9,        wherein the antineoplastic particles comprise taxane particles.    -   Embodiment 11 is the method of embodiment 10, wherein the taxane        particles comprise at least 95% of the taxane, and wherein the        taxane particles have a mean particle size (number) of from 0.1        microns to 1.5 microns.    -   Embodiment 12 is the method of any one of embodiments 10 or 11        wherein the taxane particles comprise paclitaxel particles,        docetaxel particles, cabazitaxel particles, or combinations        thereof.    -   Embodiment 13 is the method of embodiment 12, wherein the taxane        particles are paclitaxel particles.    -   Embodiment 14 is the method of embodiment 13, wherein the        paclitaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 15 is the method of any one of embodiments 13 or 14,        wherein the paclitaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 16 is the method of embodiment 12, wherein the taxane        particles are docetaxel particles.    -   Embodiment 17 is the method of embodiment 16, wherein the        docetaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 18 is the method of any one of embodiments 16 or 17,        wherein the docetaxel particles have a bulk density (not-tapped)        of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 19 is the method of any one of embodiments 1 to 18,        wherein the first composition is anhydrous.    -   Embodiment 20 is the method of any one of embodiments 1 to 19,        wherein the first composition is hydrophobic.    -   Embodiment 21. is the method of embodiment 20, wherein the first        composition comprises a hydrophobic carrier.    -   Embodiment 22 is the method of embodiment 21, wherein the        hydrophobic carrier is non-volatile.    -   Embodiment 23 is the method of any one of embodiments 21 or 22,        wherein the hydrophobic carrier is non-polar.    -   Embodiment 24 is the method of any one of embodiments 21 to 23,        wherein the hydrophobic carrier comprises a hydrocarbon.    -   Embodiment 25 is the method of embodiment 24 wherein the        hydrocarbon is petrolatum, mineral oil, or paraffin wax, or        mixtures thereof.    -   Embodiment 26 is the method of embodiment 25, wherein the        mineral oil is heavy mineral oil.    -   Embodiment 27 is the method of any one of embodiments 21 to 26,        wherein the hydrophobic carrier is greater than 50% w/w of the        hydrophobic composition.    -   Embodiment 28 is the method of any one of embodiments 1 to 27,        wherein the first composition further comprises one or more        volatile silicone fluids.    -   Embodiment 29 is the method of embodiment 28, wherein the        concentration of the one or more volatile silicone fluids is        from 5 to 24% w/w of the first composition.    -   Embodiment 30 is the method of any one of embodiments 28 or 29,        wherein the volatile silicone fluid is cyclomethicone.    -   Embodiment 31 is the method of embodiment 30, wherein the        cyclomethicone is cyclopentasiloxane.    -   Embodiment 32 is the method of any one of embodiments 1 to 31,        wherein the first composition is a semi-solid.    -   Embodiment 33 is the method of embodiment 32, wherein the        viscosity of the first composition is 25,000 cps to 500,000 cps        as measured with a Brookfield RV viscometer on a helipath stand        with the helipath on, with a T-E spindle at 10 RPM at room        temperature for 45 seconds    -   Embodiment 34 is the method of any one of embodiments 32 or 33,        wherein the first composition is an ointment.    -   Embodiment 35 is the method of any one of embodiments 1 to 35,        wherein the first composition does not contain volatile C₁-C₄        aliphatic alcohols, does not contain additional penetration        enhancers, does not contain additional volatile solvents, does        not contain surfactants, does not contain a protein, and/or does        not contain albumin.    -   Embodiment 36 is the method of any one of embodiments 1 to 35,        wherein the antineoplastic particles are dispersed in the first        composition.    -   Embodiment 37 is the method of any one of embodiments 1 to 36,        wherein the concertation of the antineoplastic particles in the        composition is from about 0.1 to about 2% w/w.    -   Embodiment 38 is a method of treating cancer in a subject, the        method comprising: (a) administering a first composition        comprising antineoplastic particles to the subject by pulmonary        administration, and (b) systemically administering a second        composition comprising an immunotherapeutic agent to the        subject, thereby treating the cancer, wherein the antineoplastic        particles have a mean particle size (number) of from 0.1 microns        to 5 microns, wherein the subject has a lung disease, and        wherein steps (a) and (b) can be conducted in any order or at        the same time.    -   Embodiment 39 is the method of embodiment 38, wherein the lung        disease is non-cancerous, and wherein the subject has cancer in        areas of the body other than in the lung.    -   Embodiment 40 is the method of embodiment 39, wherein the        non-cancerous lung disease is restrictive or obstructive lung        disease.    -   Embodiment 41 is the method of embodiment 40, wherein the        restrictive lung disease is pulmonary fibrosis.    -   Embodiment 42 is the method of embodiment 40, wherein the        obstructive lung disease is chronic obstructive lung disease        (COPD).    -   Embodiment 43 is the method of embodiment 38, wherein the lung        disease is cancerous.    -   Embodiment 44 is the method of embodiment 43, wherein the        cancerous lung disease is a malignant tumor or mesothelioma.    -   Embodiment 45 is the method of embodiment 44, wherein the        malignant tumor is a non-small cell lung cancer tumor.    -   Embodiment 46 is the method of any one of embodiments 43 to 45,        wherein the subject has cancer in other areas of the body.    -   Embodiment 47 is the method of any one of embodiments 38 to 46,        wherein the antineoplastic particles comprise taxane particles.    -   Embodiment 48 is the method of embodiment 47, wherein the taxane        particles comprise at least 95% of the taxane, and wherein the        taxane particles have a mean particle size (number) of from 0.1        microns to 1.5 microns.    -   Embodiment 49 is the method of any one of embodiments 48 or 49,        wherein the taxane particles comprise paclitaxel particles,        docetaxel particles, cabazitaxel particles, or combinations        thereof.    -   Embodiment 50 is the method of embodiment 49, wherein the taxane        particles are paclitaxel particles.    -   Embodiment 51 is the method of embodiment 50, wherein the        paclitaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 52 is the method of any one of embodiments 50 or 51,        wherein the paclitaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 53 is the method of embodiment 49, wherein the taxane        particles are docetaxel particles.    -   Embodiment 54 is the method of embodiment 53, wherein the        docetaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 55 is the method of any one of embodiments 53 or 54,        wherein the docetaxel particles have a bulk density (not-tapped)        of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 56 is the method of any one of embodiments 38 to 55,        wherein the first composition further comprises a liquid        carrier, and wherein the antineoplastic particles are dispersed        in the carrier.    -   Embodiment 57 is the method of any one of embodiments 38 to 56,        wherein the first composition is anhydrous.    -   Embodiment 58 is the method of embodiment 56, wherein the liquid        carrier is an aqueous carrier.    -   Embodiment 59 is the method of embodiment 58, wherein the        aqueous carrier comprises 0.9% saline solution.    -   Embodiment 60 is the method of any one of embodiments 58 or 59,        wherein the aqueous carrier comprises a surfactant.    -   Embodiment 61 is the method of embodiment 60, wherein the        surfactant is a polysorbate.    -   Embodiment 62 is the method of embodiment 61, wherein the        polysorbate is polysorbate 80, and wherein the polysorbate 80 is        present in the aqueous carrier at a concentration of between        about 0.01% v/v and about 1% v/v.    -   Embodiment 63 is the method of any one of embodiments 47 to 62,        wherein the concentration of the taxane particles in the first        composition is between about 1 mg/ml and about 40 mg/ml, or        between about 6 mg/mL and about 20 mg/mL.    -   Embodiment 64 is the method of any one of embodiments 38 to 63,        wherein the composition does not contain a protein such as        albumin.    -   Embodiment 65 is the method of any one of embodiments 38 to 64,        wherein the pulmonary administration comprises nebulization and        wherein the nebulizing results in pulmonary delivery to the        subject of aerosol droplets of the first composition.    -   Embodiment 66 is the method of embodiment 65, wherein the        aerosol droplets have a mass median aerodynamic diameter (MMAD)        of between about 0.5 μm to about 6 μm diameter, or between about        1 μm to about 3 μm diameter, or about 2 μm to about 3 μm        diameter.    -   Embodiment 67 is the method of any one of embodiments 38 to 66,        wherein the antineoplastic agent is detectable in lung tissue of        the subject for at least 4 days, or at least 14 days after        administration of the first composition.    -   Embodiment 68 is a method of treating cancer in a subject, the        method comprising: (a) administering a first composition        comprising antineoplastic particles directly into a solid tumor        of the subject by intratumoral injection, and (b) systemically        administering a second composition comprising an        immunotherapeutic agent to the subject, thereby treating the        cancer, wherein the antineoplastic particles have a mean        particle size (number) of from 0.1 microns to 5 microns, and        wherein steps (a) and (b) can be conducted in any order or at        the same time.    -   Embodiment 69 is the method of embodiment 68, wherein the solid        tumor is a benign tumor, and wherein the subject has cancer        elsewhere in the body.    -   Embodiment 70 is the method of embodiment 68, wherein the solid        tumor is a malignant tumor.    -   Embodiment 71 is the method of embodiment 70, wherein the        malignant tumor comprises a sarcoma, a carcinoma, a lymphoma, a        breast tumor, a prostate tumor, a head and neck tumor, a        glioblastoma, a bladder tumor, a pancreatic tumor, a liver        tumor, an ovarian tumor, a colorectal tumor, a skin tumor, a        cutaneous metastasis, a lymphoid, and/or a gastrointestinal        tumor.    -   Embodiment 72 is the method of any one of embodiments 70 or 71,        wherein the subject has cancer in other areas of the body.    -   Embodiment 73 is the method of any one of embodiments 68 to 72,        wherein the antineoplastic particles comprise taxane particles.    -   Embodiment 74 is the method of embodiment 73, wherein the taxane        particles comprise at least 95% of the taxane, and wherein the        taxane particles have a mean particle size (number) of from 0.1        microns to 1.5 microns.    -   Embodiment 75 is the method of any one of embodiments 73 or 74,        wherein the taxane particles comprise paclitaxel particles,        docetaxel particles, cabazitaxel particles, or combinations        thereof.    -   Embodiment 76 is the method of embodiment 75, wherein the taxane        particles are paclitaxel particles.    -   Embodiment 77 is the method of embodiment 76, wherein the        paclitaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 78 is the method of any one of embodiments 76 or 77,        wherein the paclitaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 79 is the method of embodiment 75, wherein the taxane        particles are docetaxel particles.    -   Embodiment 80 is the method of embodiment 79, wherein the        docetaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 81 is the method of any one of embodiments 79 or 80,        wherein the docetaxel particles have a bulk density (not-tapped)        of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 82 is the method of any one of embodiments 68 to 81,        wherein the first composition further comprises a liquid        carrier, and wherein the antineoplastic particles are dispersed        in the carrier.    -   Embodiment 83 is the method of embodiment 82, wherein the liquid        carrier is an aqueous carrier.    -   Embodiment 84 is the method of embodiment 83, wherein the        aqueous carrier comprises 0.9% saline solution.    -   Embodiment 85 is the method of any one of embodiments 83 or 84,        wherein the aqueous carrier comprises a surfactant.    -   Embodiment 86 is the method of embodiment 85, wherein the        surfactant is a polysorbate.    -   Embodiment 87 is the method of embodiment 86, wherein the        polysorbate is polysorbate 80, and wherein the polysorbate 80 is        present in the aqueous carrier at a concentration of between        about 0.01% v/v and about 1% v/v.    -   Embodiment 88 is the method of any one of embodiments 73 to 88,        wherein the concentration of the taxane particles in the first        composition is between about 1 mg/ml and about 40 mg/ml, or        between about 6 mg/mL and about 20 mg/mL.    -   Embodiment 89 is the method of any one of embodiments 68 to 88,        wherein the composition does not contain a protein such as        albumin.    -   Embodiment 90 is a method of treating cancer in a subject, the        method comprising: (a) administering a first composition        comprising antineoplastic particles to an intraperitoneal organ        tumor of the subject by intraperitoneal injection, and (b)        systemically administering a second composition comprising an        immunotherapeutic agent to the subject, thereby treating the        cancer, wherein the antineoplastic particles have a mean        particle size (number) of from 0.1 microns to 5 microns, and        wherein steps (a) and (b) can be conducted in any order or at        the same time.    -   Embodiment 91 is the method of embodiment 90, wherein the tumor        is benign and wherein the subject has cancer elsewhere in the        body.    -   Embodiment 92 is the method of embodiment 90, wherein the tumor        is malignant.    -   Embodiment 93 is the method of embodiment 92, wherein the        subject has cancer in other areas of the body.    -   Embodiment 94 is the method of any one of embodiments 90 to 93,        wherein the tumor is an ovarian tumor.    -   Embodiment 95 is the method of any one of embodiments 90 to 94,        wherein the antineoplastic particles comprise taxane particles.    -   Embodiment 96 is the method of embodiment 95, wherein the taxane        particles comprise at least 95% of the taxane, and wherein the        taxane particles have a mean particle size (number) of from 0.1        microns to 1.5 microns.    -   Embodiment 97 is the method of any one of embodiments 95 or 96,        wherein the taxane particles comprise paclitaxel particles,        docetaxel particles, cabazitaxel particles, or combinations        thereof.    -   Embodiment 98 is the method of embodiment 97, wherein the taxane        particles are paclitaxel particles.    -   Embodiment 99 is the method of embodiment 98, wherein the        paclitaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 100 is the method of any one of embodiments 98 or 99,        wherein the paclitaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 101 is the method of embodiment 97, wherein the        taxane particles are docetaxel particles.    -   Embodiment 102 is the method of embodiment 101, wherein the        docetaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 103 is the method of any one of embodiments 101 or        102, wherein the docetaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 104 is the method of any one of embodiments 90 to        103, wherein the first composition further comprises a liquid        carrier, and wherein the antineoplastic particles are dispersed        in the carrier.    -   Embodiment 105 is the method of embodiment 104, wherein the        liquid carrier is an aqueous carrier.    -   Embodiment 106 is the method of embodiment 105, wherein the        aqueous carrier comprises 0.9% saline solution.    -   Embodiment 107 is the method of any one of embodiments 105 or        106, wherein the aqueous carrier comprises a surfactant.    -   Embodiment 108 is the method of embodiment 107, wherein the        surfactant is a polysorbate.    -   Embodiment 109 is the method of embodiment 108, wherein the        polysorbate is polysorbate 80, and wherein the polysorbate 80 is        present in the aqueous carrier at a concentration of between        about 0.01% v/v and about 1% v/v.    -   Embodiment 110 is the method of any one of embodiments 95 to        109, wherein the concentration of the taxane particles in the        first composition is between about 1 mg/ml and about 40 mg/ml,        or between about 6 mg/mL and about 20 mg/mL.    -   Embodiment 111 is the method of any one of embodiments 90 to        110, wherein the composition does not contain a protein such as        albumin.    -   Embodiment 112 is the method of any one of embodiments 1 to 111,        wherein the immunotherapeutic agent is a monoclonal antibody, a        cancer vaccine, a non-specific immunotherapeutic agent, a        cytokine, interferon, interleukin, a colony stimulating factor,        a checkpoint inhibitor, an immune modulator, an adoptive cell        transfer agent, a T-cell therapeutic agent, a cellular        therapeutic agent, an oncolytic virus therapeutic agent, BCG,        and/or an adjuvant immunotherapeutic agent.    -   Embodiment 113 is the method of embodiment 112, wherein the        immunotherapeutic agent is a monoclonal antibody.    -   Embodiment 114 is the method of embodiment 113, wherein the        monoclonal antibody is pembrolizumab.    -   Embodiment 115 is the method of any one of embodiments 1 to 114,        wherein the second composition comprises a pharmaceutically        acceptable carrier.    -   Embodiment 116 is the method of any one of embodiments 1 to 115,        wherein the systemic administration is intravenous (IV)        injection or oral delivery.    -   Embodiment 117 is the method of any one of embodiment 1 to 116,        wherein the first composition is administered at least one day        prior to the administration of the second composition.    -   Embodiment 118 is the method of any one of embodiments 1 to 116,        wherein the second composition is administered at least one day        prior to the administration of the first composition.    -   Embodiment 119 is the method of any one of embodiments 1 to 116,        wherein the first composition and the second composition are        administered on the same day.    -   Embodiment 120 is the method of any one of embodiment 1 to 119,        wherein the amount of antineoplastic particles in the first        composition and the amount of immunotherapeutic agent in the        second composition are at effective amounts to treat the cancer        in the subject and optionally to treat the tumor of the subject.    -   Embodiment 121 is the method of any one of embodiments 1 to 120,        wherein the local administration of the first composition        stimulates an immunological response to the immunotherapeutic        agent in the subject after the systemic administration of the        second composition.    -   Embodiment 122 is a kit comprising: (a) a first composition        comprising taxane particles, wherein the taxane particles have a        mean particle size (number) of from 0.1 microns to 5        microns, (b) a second composition comprising an        immunotherapeutic agent, and (c) instructions for (i)        administering the first composition locally to a subject,        and (ii) administering the second composition systemically to        the subject.    -   Embodiment 123. The kit of embodiment 112, wherein the        immunotherapeutic agent is a monoclonal antibody, a cancer        vaccine, a non-specific immunotherapeutic agent, a cytokine,        interferon, interleukin, a colony stimulating factor, a        checkpoint inhibitor, an immune modulator, an adoptive cell        transfer agent, a T-cell therapeutic agent, a cellular        therapeutic agent, an oncolytic virus therapeutic agent, BCG,        and/or an adjuvant immunotherapeutic agent.    -   Embodiment 124 is the kit of any one of embodiments 122 or 123,        wherein the taxane particles comprise at least 95% of the        taxane, and wherein the taxane particles have a mean particle        size (number) of from 0.1 microns to 1.5 microns.    -   Embodiment 125 is the kit of any one of embodiments 122 to 124        wherein the taxane particles are paclitaxel particles, docetaxel        particles, cabazitaxel particles, or combination thereof.    -   Embodiment 126 is the kit of embodiment 125, wherein the taxane        particles are paclitaxel particles.    -   Embodiment 127 is the kit of embodiment 126, wherein the        paclitaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 128 is the kit of any one of embodiments 126 or 127,        wherein the paclitaxel particles have a bulk density        (not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 129 is the kit of embodiment 125, wherein the taxane        particles are docetaxel particles.    -   Embodiment 130 is the kit of embodiment 129, wherein the        docetaxel particles have a specific surface area (SSA) of at        least 18 m²/g.    -   Embodiment 131 is the kit of any one of embodiments 129 or 130,        wherein the docetaxel particles have a bulk density (not-tapped)        of 0.05 g/cm³ to 0.15 g/cm³.    -   Embodiment 132 is the kit of embodiment 125, wherein the first        composition is a hydrophobic ointment.    -   Embodiment 133 is the kit of embodiment 125, wherein the first        composition is an aqueous suspension.

The term “antineoplastic agents” as used herein are drugs used to treatneoplasms including cancer, and include “chemotherapeutic agents”, whichare drugs used to treat cancer. In a preferred embodiment, theantineoplastic agent is a taxane.

The terms “antineoplastic agent particles”, “antineoplastic particles”or “particles of an antineoplastic agent(s)”, as used herein areparticles of an antineoplastic agent and have a mean particle size(number) of from about 0.1 microns to about 5 microns (about 100 nm toabout 5000 nm) in diameter. In a preferred embodiment, theantineoplastic particles are taxane particles.

The term “tumor” as used herein means one or more abnormal masses oftissue that results when cells divide more than they should or do notdie when they should. Tumors may be benign (not cancer), or malignant(cancer).

The term “hydrophobic,” as used herein, describes compounds,compositions, or carriers that have a solubility in water of less thanor equal to 10 mg/mL at room temperature.

The term “volatile,” as used herein, describes compounds, compositions,or carriers that have a vapor pressure greater than or equal to 10 Pa atroom temperature.

The term “non-volatile,” as used herein, describes compounds,compositions, or carriers that have a vapor pressure less than 10 Pa atroom temperature.

The term “anhydrous,” as used herein with regard to the compositions orcarriers of the invention, means that less than 3% w/w, preferably lessthan 2% w/w, more preferably less than 1% w/w, or most preferably 0% w/wof water is present in the compositions or carriers. This can accountfor small amounts of water being present (e.g., water inherentlycontained in any of the ingredients of the compositions or carriers,water contracted from the atmosphere, etc.).

The terms “skin” or “cutaneous” as used herein mean the epidermis and/orthe dermis.

The term “skin tumor” as used herein includes benign skin tumors andmalignant skin tumors.

The terms “skin malignancy” or “malignant skin tumor” as used hereinincludes cancerous skin tumors which includes skin cancers and cutaneousmetastases.

The “affected area” of a skin tumor or skin malignancy can include atleast a portion of the skin where the skin tumor or skin malignancy isvisibly present on the outermost surface of the skin or directlyunderneath the surface of the skin (epithelial/dermal covering), and caninclude areas of the skin in the proximity of the skin tumor or skinmalignancy likely to contain visibly undetectable preclinical lesions.

The terms “cutaneous (skin) metastasis” or “cutaneous (skin) metastases”(plural) as used herein means the manifestation of a malignancy in theskin as a secondary growth (malignant tumor) arising from the primarygrowth of a cancer tumor at another location of the body. Spread fromthe primary tumor can be through the lymphatic or blood circulationsystems, or by other means.

The terms “treat”, “treating”, or “treatment” as used herein withrespect to treatment of cancer and/or treatment of a tumor meansaccomplishing one or more of the following: (a) reducing tumor size; (b)reducing tumor growth; (c) eliminating a tumor; (d) reducing or limitingdevelopment and/or spreading of metastases; (e) obtaining partial orcomplete remission of cancer.

The terms “subject” or “patient” as used herein mean a vertebrateanimal. In some embodiments, the vertebrate animal can be a mammal. Insome embodiments, the mammal can be a primate, including a human.

The term “room temperature” (RT) as used herein, means 15-30° C. or20-25° C.

The term “penetration enhancer” or “skin penetration enhancer” as usedherein, means a compound or a material or a substance that facilitatesdrug absorption into the skin (epidermis and dermis).

The term “surfactant” or “surface active agent” as used herein, means acompound or a material or a substance that exhibits the ability to lowerthe surface tension of water or to reduce the interfacial tensionbetween two immiscible substances.

As used herein, the singular forms “a”, “an” and “the” include pluralreferents unless the context clearly dictates otherwise. “And” as usedherein is interchangeably used with “or” unless expressly statedotherwise.

The terms “about” or “approximately” as used herein mean+/−five percent(5%) of the recited unit of measure.

For this application, a number value with one or more decimal places canbe rounded to the nearest whole number using standard roundingguidelines, i.e. round up if the number being rounded is 5, 6, 7, 8, or9; and round down if the number being rounded is 0, 1, 2, 3, or 4. Forexample, 3.7 can be rounded to 4.

Unless the context clearly requires otherwise, throughout thedescription and the claims, the words “comprise”, “comprising”, and thelike are to be construed in an inclusive or open-ended sense as opposedto an exclusive or exhaustive sense; that is to say, in the sense of“including, but not limited to”. Words using the singular or pluralnumber also include the plural and singular number, respectively.Additionally, the words “herein,” “above,” and “below” and words ofsimilar import, when used in this application, shall refer to thisapplication as a whole and not to any particular portions of theapplication. The compositions and methods for their use can “comprise,”“consist essentially of,” or “consist of” any of the ingredients orsteps disclosed throughout the specification. With respect to the phrase“consisting essentially of,” a basic and novel property of the methodsof the present invention are their ability to treat cancer by localdelivery of compositions of antineoplastic particles combined withsystemic delivery of compositions of immunotherapeutic agents.

It is contemplated that any embodiment discussed in this specificationcan be implemented with respect to any method or composition of theinvention, and vice versa. Furthermore, compositions of the inventioncan be used to achieve methods of the invention.

The description of embodiments of the disclosure is not intended to beexhaustive or to limit the disclosure to the precise form disclosed.While the specific embodiments of, and examples for, the disclosure aredescribed herein for illustrative purposes, various equivalentmodifications are possible within the scope of the disclosure, as thoseskilled in the relevant art will recognize.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 graphically shows the concentration of paclitaxel (μg/cm2)delivered in vitro into the epidermis for formulas F1 through F7.

FIG. 2 graphically shows the concentration of paclitaxel (μg/cm2)delivered in vitro into the epidermis for formulas F6*(repeat analysis)and F8 through F13.

FIG. 3 graphically shows the concentration of paclitaxel (μg/cm2)delivered in vitro into the dermis for formulas F1 through F7.

FIG. 4 graphically shows the concentration of paclitaxel (μg/cm2)delivered in vitro into the dermis for formulas F6*(repeat analysis) andF8 through F13.

FIG. 5 is a photo of a skin metastatic lesion on the chest of a womanwith Stage 4 breast cancer at baseline (Day 1) in cutaneous metastasisstudy.

FIG. 6 is a photo of a skin metastatic lesion on the chest of a womanwith Stage 4 breast cancer at Day 8 during topical treatment incutaneous metastasis study.

FIG. 7 is a photo of a skin metastatic lesion on the chest of a womanwith Stage 4 breast cancer at Day 15 during topical treatment incutaneous metastasis study.

FIG. 8 a is a photo of a skin metastatic lesion on the chest of a womanwith Stage 4 breast cancer at Day 29 during topical treatment at studyend in cutaneous metastasis study.

FIG. 8 b is a photo of a skin metastatic lesion on the chest of a womanwith Stage 4 breast cancer at Day 43 two weeks after topical treatmentended in cutaneous metastasis study.

FIG. 9 is a plot of the particle size distribution for 6.0 mg/mLNanoPac® formulation aerosols as measured by cascade impactor.

FIG. 10 is a plot of the particle size distribution for 20.0 mg/mLNanoPac® formulation aerosols as measured by cascade impactor.

FIG. 11 is a graph of paclitaxel levels in plasma over time afterpulmonary administration in rats.

FIG. 12 is a graph of paclitaxel levels in lung tissue over time afterpulmonary administration in rats.

FIG. 13 is a graph of animal body weight over time from Orthotopic LungCancer study.

FIG. 14 is a graph of animal body weight change over time fromOrthotopic Lung Cancer study.

FIG. 15 is a plot of animal lung weights from Orthotopic Lung Cancerstudy.

FIG. 16 is a plot of animal lung to body weight ratios from OrthotopicLung Cancer study.

FIG. 17 is a plot of animal lung to brain weight ratios from OrthotopicLung Cancer study.

FIG. 18 is a graph of average tumor areas from Orthotopic Lung Cancerstudy.

FIG. 19 is a plot of average tumor areas from Orthotopic Lung Cancerstudy.

FIG. 20 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—1006 (Control) Adenocarcinoma-3, Primitive-1, Regression-0.Primary characteristics of the lung tumor masses. (2×).

FIG. 21 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—2003 (IV Abraxane) Adenocarcinoma-1, Primitive-1,Regression-1. Characteristics of the lung tumor masses undergoingregression. (4×).

FIG. 22 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—2010 (IV Abraxane) Adenocarcinoma-3, Primitive-1,Regression-0. Primary characteristics of the lung tumor masses. (2×).

FIG. 23 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—4009 (IH NanoPac® 1× High) Adenocarcinoma-0, Primitive-0,Regression-4. Characteristics of the lung tumor masses that haveundergone complete regression. (2×).

FIG. 24 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—5010 (IH NanoPac® 2× Low) Adenocarcinoma-1, Primitive-0,Regression-3. Characteristics of the lung tumor masses undergoingregression. (2×).

FIG. 25 is a photomicrograph of H&E Stained Orthotopic Lung Cancertissue slide—6005 (IH NanoPac® 2× High) Adenocarcinoma-1, Primitive-0,Regression-4. Characteristics a lung tumor mass that is undergoingregression. (2×).

FIG. 26 is a plot of tumor regression from Orthotopic Lung Cancer study.

FIG. 27 are various photomicrographs of the Orthotopic Lung Cancertissue slides—(Control). Top row: H/E stained sections. Bottom row:Immunohistochemical staining with Keratin or CD11b.

FIG. 28 are various photomicrograph of the Orthotopic Lung Cancer tissueslides—(IV Abraxane). Top row: H/E stained sections. Bottom row:Immunohistochemical staining with Keratin or CD11b.

FIG. 29 are various photomicrographs of the Orthotopic Lung Cancertissue slides—(Inhaled NanoPac®). Various staining with H/E stain,Trichrome, Keratin and CD11b.

FIG. 30 are various photomicrograph of the Orthotopic Lung Cancer tissueslides showing presence of TLSs.

FIG. 31 is a graph of mean tumor volumes over time from the bladdercancer xenograft study. The arrows on the x-axis represent theadministration points.

FIG. 32 is a graph of individual tumor volumes over time for Vehicle 3cycles from the bladder cancer xenograft study. The triangles on thex-axis represent an administration point.

FIG. 33 is a graph of individual tumor volumes over time for theDocetaxel IV 3 cycles from the bladder cancer xenograft study. Thetriangles on the x-axis represent the administration points.

FIG. 34 is a graph of individual tumor volumes over time for theNanoDoce® IT 1 cycle from the bladder cancer xenograft study. Thetriangle on the x-axis represent the single administration point.

FIG. 35 is a graph of individual tumor volumes over time for theNanoDoce® IT 2 cycles from the bladder cancer xenograft study. Thetriangles on the x-axis represent the administration points.

FIG. 36 is a graph of individual tumor volumes over time for theNanoDoce® 3 cycles from the bladder cancer xenograft study. Thetriangles on the x-axis represent the administration points.

FIG. 37 is a scatter plot of tumor volumes at end of study over tumorvolumes at Day 1 treatment from the bladder cancer xenograft study.

FIG. 38 is a graph of mean body weights over time from the bladdercancer xenograft study. The arrows on the x-axis represent theadministration points.

FIG. 39 is a graph of mean tumor volumes at Day 61 for eachadministration group from the bladder cancer xenograft study.

FIG. 40 are photos of animals from each administration group at Day 27,Day 40 and Day 61 post tumor implant from the bladder cancer xenograftstudy.

FIG. 41 a graph of concentrations of docetaxel in tumor tissue forNanoDoce® 1 cycle, 2 cycles, and 3 cycles from the bladder cancerxenograft study.

FIG. 42 is a photomicrograph of bladder cancer xenograft tissue slide—ITVehicle Control. H&E. Magnification 2.52×.

FIG. 43 is a photomicrograph of bladder cancer xenograft tissue slide—ITVehicle Control. H&E. Magnification 6.3×.

FIG. 44 is a photomicrograph of bladder cancer xenograft tissue slide—ITVehicle Control. H&E. Magnification 25.2×.

FIG. 45 is a photomicrograph of bladder cancer xenograft tissue slide—IVDocetaxel 3 cycles. H&E. Magnification 2.52×.

FIG. 46 is a photomicrograph of bladder cancer xenograft tissue slide—IVDocetaxel 3 cycles. H&E. Magnification 6.3×.

FIG. 47 is a photomicrograph of bladder cancer xenograft tissue slide—IVDocetaxel 3 cycles. H&E. Magnification 25.2×.

FIG. 48 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 2 cycles. H&E. Magnification 2.52×.

FIG. 49 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 2 cycles. H&E. Magnification 6.3×.

FIG. 50 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 3 cycles. H&E. Magnification 2.52×.

FIG. 51 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 3 cycles. H&E. Magnification 2.52×.

FIG. 52 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 3 cycles. H&E. Magnification 25.2×.

FIG. 53 is a photomicrograph of bladder cancer xenograft tissue slide—ITVehicle Control 3 cycles F4/80 stain. Magnification 2.52×.

FIG. 54 is a photomicrograph of bladder cancer xenograft tissue slide—IVDocetaxel 3 cycles F4/80 stain. Magnification 2.52×.

FIG. 55 is a photomicrograph of bladder cancer xenograft tissue slide—ITNanoDoce® 3 cycles F4/80 stain. Magnification 2.52×.

FIG. 56 is a photomicrograph of renal cell adenocarcinoma xenografttissue slide from female rat—Non-treated. H&E. Magnification 6.3×.

FIG. 57 is a photomicrograph of renal cell adenocarcinoma xenografttissue slide from female rat—Vehicle Control (IT) 3 cycles. H&E.Magnification 6.3×.

FIG. 58 is a photomicrograph of renal cell adenocarcinoma xenografttissue slide from female rat—Docetaxel solution (IV) 3 cycles. H&E.Magnification 6.3×.

FIG. 59 is a photomicrograph of renal cell adenocarcinoma xenografttissue slide from female rat—NanoDoce® (IT) 3 cycles. H&E. Magnification6.3×.

FIG. 60 are various photomicrographs of Control Cases of renal celladenocarcinoma xenograft tissue slides. Top row: H&E stained sections.Bottom row: Immunohistochemical staining.

FIG. 61 are various photomicrographs of IT NanoDoce® cases of renal celladenocarcinoma xenograft tissue slides. Top row: One cycle NanoDoce®(1×). Second row: One cycle NanoDoce® (1×). Third row: Two cyclesNanoDoce® (2×). Fourth row: Two cycles NanoDoce® (2×). Fifth row: Threecycles NanoDoce® (3×).

FIG. 62 is a graph of mean tumor volumes over time of rats in theNanoPac® groups from the renal cell adenocarcinoma xenograft study. Thetriangles on the x-axis represent the administration points.

FIG. 63 is a graph of mean tumor volumes over time of rats in theNanoDoce® groups from the renal cell adenocarcinoma xenograft study. Thetriangles on the x-axis represent the administration points.

DETAILED DESCRIPTION

The present invention provides methods to treat cancer through the useof combined local and systemic therapies, i.e., local administration ofantineoplastic agent particles (chemotherapeutic particles), such astaxane particles, directly to a tumor as an adjuvant to systemicadministration of an immunotherapeutic agent.

When antineoplastic particles such as taxane particles (for examplepaclitaxel particles or docetaxel particles) are administered locally toeither benign or malignant tumors, (i.e., injected intratumorally,injected intraperitoneally, deposited in the lung by inhalation, oradministered topically onto skin tumors or skin malignancies such ascutaneous metastases), the molecules of the anti-neoplastic agent (forexample paclitaxel or docetaxel) persist at the tumor site for a longertime than when antineoplastic agents are administered as solutions by IVat high concentrations. Locally administered antineoplastic particlessuch as taxane particles can therefore function as local adjuvants tosystemic immunotherapy. Without being limited to any specific mechanism,such adjuvant effect may comprise, for example, providing sufficienttime for lymphocytes to activate both their innate as well as adaptiveimmunological response to the tumor, all without the added associatedtoxicities of IV chemotherapy.

Immune system stimulation that occurs in response to the localadministration of taxane particles, including activation of the localdendritic cell's response to tumor antigens, can be enhanced for exampleby the topical administration of taxane particles to the skin or bypulmonary inhalation of taxane particles. Without being limited to anyspecific mechanism, local tumor cell killing by the administration oftaxane particles releases tumor cell antigens which are attached todendritic cells. The activated dendritic cells may then presenttumor-specific antigen to T-cells and other tumoricidal cells thatcirculate throughout the patient's vascular system as well as entertissues that contain tumor allowing for destruction of cancer throughoutthe patient. Thus, the use of local particle administration allows fordirect local therapy, as well as indirect immune system-mediatedsystemic cancer cell killing.

By local administration of taxane particles either by topical therapy ofskin tumors, intratumoral injection of solid tumors, intraperitonealinjection, or inhalation therapy of lung diseases, the local taxanemolecules act as an adjuvant to stimulate the immune response. Localconcentration of taxane remains elevated for greater than 4 days whichprovides sufficient time for killing of local tumor cells as well asstimulation of the immune response appropriate for killing of cancerthat may be widely disseminated through the body. This stimulation ofthe immune system by local administration of taxane particles occurswithout producing concomitant high levels of taxane in the patient'scirculating blood. Thus, local administration of particle taxane doesnot reduce hematopoiesis in the bone marrow involving reduction in whiteblood cell numbers such as lymphocytes. Bone marrow suppression is acommon side effect of taxanes when given IV due to the highconcentrations of circulating taxane.

Without being limited to any specific mechanism, local administration oftaxane particles may produce sufficient concentrations of taxanes for aprolonged period to stimulate local immunological response toimmunotherapy through activation in dendritic cells. Activation ofdendritic cells can occur most notably in the skin or lung where theyare found in abundance. Topical administration of taxane particles toskin tumors causes entry of paclitaxel into tumor cells which kills themduring their division cycle rendering them more accessible to immunerecognition by immunotherapy. The lymphocytes would then circulatethroughout the patient's body producing humoral mediators that arespecific to the cell surface antigens of the tumor cells. Thelymphocytes destroy tumor located in the skin as well as distantmetastasis. Lymphocyte tumor killing could also occur via the cellularroute of immune surveillance. For example, topical administration oftaxane particles to a cutaneous metastasis would result in eradicationof the patient's cancer throughout their body, not just the cutaneousmetastasis. The same elimination of cancer in the body would happen tometastatic lung cancer in response to inhaled taxane particles.

Thus, the cancer treatment methods of the invention include the use ofcombined local and systemic therapies. i.e., local administration ofcompositions comprising antineoplastic agent particles, such as taxaneparticles, directly to a tumor; combined with systemic administration ofcompositions comprising immunotherapeutic agents. The localadministration of the antineoplastic agent particles, e.g. taxaneparticles, functions as local adjuvants to systemic immunotherapyproviding sufficient time for lymphocytes to activate both their innateas well as adaptive immunological response to the tumor.

Treatment with the combination of the local administration of acomposition comprising antineoplastic particles and the systemicadministration of an immunotherapeutic agent demonstrates greaterefficacy than the treatment with an immunotherapeutic agent alone and/orthe treatment with a composition comprising antineoplastic particlesalone (monotherapy) as evidenced by at least one of the following:

-   -   (a) greater reduction of tumor size with the animals treated        with the combination of a composition comprising antineoplastic        particles and an immunotherapeutic agent than with the animals        treated with an immunotherapeutic agent alone, or    -   (b) greater reduction in tumor growth with the animals treated        with the combination of a composition comprising antineoplastic        particles and an immunotherapeutic agent than with the animals        treated with an immunotherapeutic agent alone, or    -   (c) one or more incidences of tumor elimination with the animals        treated with the combination of a composition comprising        antineoplastic particles and an immunotherapeutic agent versus        no incidences of tumor elimination with the animals treated with        an immunotherapeutic agent alone, or    -   (d) greater reduction of tumor size with the animals treated        with the combination of a composition comprising antineoplastic        particles and an immunotherapeutic agent than with the animals        treated with a composition comprising antineoplastic particles        alone, or    -   (e) greater reduction in tumor growth with the animals treated        with the combination of a composition comprising antineoplastic        particles and an immunotherapeutic agent than with the animals        treated with a composition comprising antineoplastic particles        alone, or    -   (f) one or more incidences of tumor elimination with the animals        treated with the combination of a composition comprising        antineoplastic particles and an immunotherapeutic agent versus        no incidences of tumor elimination with the animals treated with        a composition comprising antineoplastic particles alone.    -   Also, a synergistic effect on efficacy is realized with the        combination of a composition comprising antineoplastic particles        administered locally and an immunotherapeutic agent administer        systemically as evidenced by at least one of the following:    -   (g) the reduction of tumor size of the animals treated with the        combination of a composition comprising antineoplastic particles        and an immunotherapeutic agent is greater than the sum of the        reductions of the tumor size of the animals treated with an        immunotherapeutic agent alone plus those treated with a        composition comprising antineoplastic particles alone, or    -   (h) the reduction of tumor growth of the animals treated with        the combination of a composition comprising antineoplastic        particles and an immunotherapeutic agent is greater than the sum        of the reductions of the tumor growth of the animals treated        with an immunotherapeutic agent alone plus those treated with a        composition comprising antineoplastic particles alone, or    -   (i) the number of incidences of tumor elimination of the animals        treated with the combination of a composition comprising        antineoplastic particles and an immunotherapeutic agent is        greater than the sum of the number of incidences of tumor        elimination of the animals treated with Pembrolizumab alone plus        those treated with a composition comprising antineoplastic        particles alone.

I. Antineoplastic Agent Particles

Antineoplastic agents are drugs used to treat neoplasms includingcancer, and include “chemotherapeutic agents”, which are drugs used totreat cancer. Suitable antineoplastic agents include those thatstimulate an immunological response when administered to a subject.Non-limiting examples of antineoplastic agents can be found listed inthe “Ashgate Handbook of Antineoplastic Agents”, published by GowerPublishing Limited, 2000, herein incorporated by reference.Antineoplastic agent particles have a mean particle size (number) offrom about 0.1 microns to about 5 microns (about 100 nm to about 5000nm) in diameter. In some embodiments, the antineoplastic agent particleshave a mean particle size (number) of from about 0.1 microns to about1.5 microns (about 100 nm to about 1500 nm) in diameter. In someembodiments, the antineoplastic agent particles have a mean particlesize (number) of from about 0.1 microns to less than 1 micron (about 100nm to less than 1000 nm) in diameter. The antineoplastic agent particlesare in a size range where they are unlikely to be carried out of thetumor by systemic circulation and yet benefit from the high specificsurface area to provide enhanced solubilization and release of the drug.

In some embodiments, the antineoplastic particles are solid, uncoated(“neat” or “naked”) individual particles. In some embodiments, theantineoplastic particles are not bound to any substance. In someembodiments, no substances are absorbed or adsorbed onto the surface ofthe antineoplastic particles. In some embodiments, the antineoplasticagents or antineoplastic particles are not encapsulated, contained,enclosed or embedded within any substance. In some embodiments, theantineoplastic particles are not coated with any substance. In someembodiments, the antineoplastic particles are not microemulsions,nanoemulsions, microspheres, or liposomes containing an antineoplasticagent. In some embodiments, the antineoplastic particles are not boundto, encapsulated in, or coated with a monomer, a polymer (orbiocompatible polymer), a protein, a surfactant, or albumin. In someembodiments, a monomer, a polymer (or biocompatible polymer), a protein,a surfactant, or albumin is not absorbed or adsorbed onto the surface ofthe antineoplastic particles. In some embodiments, the antineoplasticparticles are in crystalline form. In other embodiments, theantineoplastic particles are in amorphous form, or a combination of bothcrystalline and amorphous form. In some embodiments, the antineoplasticparticles of the invention contain traces of impurities and byproductstypically found during preparation of the antineoplastic agent. In someembodiments, the antineoplastic particles comprise at least 90%, atleast 95%, at least 96%, at least 97%, at least 98%, at least 99% or100% of the antineoplastic agent, meaning the antineoplastic particlesconsist of or consist essentially of substantially pure antineoplasticagent.

In some embodiments, the antineoplastic particles are coated with orbound to a substance such as a protein (e.g., albumin), a monomer, apolymer, a biocompatible polymer, or a surfactant. In some embodiments,a substance such as a protein (e.g., albumin), a monomer, a polymer, abiocompatible polymer, or a surfactant is adsorbed or absorbed onto thesurface of the antineoplastic particles. In some embodiments, theantineoplastic particles are encapsulated, contained, enclosed, orembedded within a substance such as a protein (e.g., albumin), amonomer, a polymer, a biocompatible polymer, or a surfactant. In someembodiments, the antineoplastic particles are microemulsions,nanoemulsions, microspheres, or liposomes containing an antineoplasticagent. In some embodiments, the antineoplastic particles arenon-agglomerated individual particles and are not clusters of multipleantineoplastic particles that are bound together by interactive forcessuch as non-covalent interactions, van der Waal forces, hydrophilic orhydrophobic interactions, electrostatic interactions, Coulombic forces,interactions with a dispersion material, or interactions via functionalgroups. In some embodiments, the taxane particles are individualantineoplastic particles that are formed by the agglomeration of smallerparticles which fuse together forming the larger individualantineoplastic particles, all of which occurs during the processing ofthe antineoplastic particles. In other embodiments, the antineoplasticparticles are clusters or agglomerates of antineoplastic particles thatare bound together by interactive forces such as non-covalentinteractions, van der Waal forces, hydrophilic or hydrophobicinteractions, electrostatic interactions, Coulombic forces, interactionswith a dispersion material, or interactions via functional groups.

In a preferred embodiment, the antineoplastic particles are taxaneparticles. Taxanes are poorly water-soluble compounds generally having asolubility of less than or equal to 10 mg/mL in water at roomtemperature. Taxanes are widely used as antineoplastic agents andchemotherapy agents. The term “taxanes” as used herein includepaclitaxel (I), docetaxel (II), cabazitaxel (III), and any other taxaneor taxane derivatives, non-limiting examples of which are taxol B(cephalomannine), taxol C, taxol D, taxol E, taxol F, taxol G,taxadiene, baccatin III, 10-deacetylbaccatin, taxchinin A, brevifoliol,and taxuspine D, and also include pharmaceutically acceptable salts oftaxanes.

Paclitaxel and docetaxel active pharmaceutical ingredients (APIs) arecommercially available from Phyton Biotech LLC, Vancouver, Canada. Thedocetaxel API contains not less than 90%, or not less than 95%, or notless than 97.5% docetaxel calculated on the anhydrous, solvent-freebasis. The paclitaxel API contains not less than 90%, or not less than95%, or not less than 97% paclitaxel calculated on the anhydrous,solvent-free basis. In some embodiments, the paclitaxel API anddocetaxel API are USP and/or EP grade. Paclitaxel API can be preparedfrom a semisynthetic chemical process or from a natural source such asplant cell fermentation or extraction. Paclitaxel is also sometimesreferred to by the trade name TAXOL, although this is a misnomer becauseTAXOL is the trade name of a solution of paclitaxel in polyoxyethylatedcastor oil and ethanol intended for dilution with a suitable parenteralfluid prior to intravenous infusion. Taxane APIs can be used to maketaxane particles. The taxane particles can be paclitaxel particles,docetaxel particles, or cabazitaxel particles, or particles of othertaxane derivatives, including particles of pharmaceutically acceptablesalts of taxanes.

Taxane particles have a mean particle size (number) of from about 0.1microns to about 5 microns (about 100 nm to about 5000 nm) in diameter.In preferred embodiments, the taxane particles are solid, uncoated(neat) individual particles. The taxane particles are in a size rangewhere they are unlikely to be carried out of the tumor by systemiccirculation and yet benefit from the high specific surface area toprovide enhanced solubilization and release of the drug. In someembodiments, the taxane particles are not bound to any substance. Insome embodiments, no substances are absorbed or adsorbed onto thesurface of the taxane particles. In some embodiments, the taxane ortaxane particles are not encapsulated, contained, enclosed or embeddedwithin any substance. In some embodiments, the taxane particles are notcoated with any substance. In some embodiments, the taxane particles arenot microemulsions, nanoemulsions, microspheres, or liposomes containinga taxane. In some embodiments, the taxane particles are not bound to,encapsulated in, or coated with a monomer, a polymer (or biocompatiblepolymer), a protein, a surfactant, or albumin. In some embodiments, amonomer, a polymer (or biocompatible polymer), a protein, a surfactant,or albumin is not absorbed or adsorbed onto the surface of the taxaneparticles. In some embodiments, the composition and the taxane particlesexclude albumin. In some embodiments, the taxane particles are incrystalline form. In other embodiments, the taxane particles are inamorphous form, or a combination of both crystalline and amorphous form.In some embodiments, the taxane particles of the invention containtraces of impurities and byproducts typically found during preparationof the taxane. In some embodiments, the taxane particles comprise atleast 90%, at least 95%, at least 96%, at least 97%, at least 98%, atleast 99% or 100% of the taxane, meaning the taxane particles consist ofor consist essentially of substantially pure taxane.

In some embodiments, the taxane particles are coated with or bound to asubstance such as a protein (e.g., albumin), a monomer, a polymer, abiocompatible polymer, or a surfactant. In some embodiments, a substancesuch as a protein (e.g., albumin), a monomer, a polymer, a biocompatiblepolymer, or a surfactant is adsorbed or absorbed onto the surface of thetaxane particles. In some embodiments, the taxane particles areencapsulated, contained, enclosed, or embedded within a substance suchas a protein (e.g., albumin), a monomer, a polymer, a biocompatiblepolymer, or a surfactant. In some embodiments, the taxane particles aremicroemulsions, nanoemulsions, microspheres, or liposomes containing ataxane. In some embodiments, the taxane particles are non-agglomeratedindividual particles and are not clusters of multiple taxane particlesthat are bound together by interactive forces such as non-covalentinteractions, van der Waal forces, hydrophilic or hydrophobicinteractions, electrostatic interactions, Coulombic forces, interactionswith a dispersion material, or interactions via functional groups. Insome embodiments, the taxane particles are individual taxane particlesthat are formed by the agglomeration of smaller particles which fusetogether forming the larger individual taxane particles, all of whichoccurs during the processing of the taxane particles. In someembodiments, the taxane particles are clusters or agglomerates of taxaneparticles that are bound together by interactive forces such asnon-covalent interactions, van der Waal forces, hydrophilic orhydrophobic interactions, electrostatic interactions, Coulombic forces,interactions with a dispersion material, or interactions via functionalgroups.

The antineoplastic particles or taxane particles (including paclitaxelparticles, docetaxel particles, or cabazitaxel particles) can have amean particle size (number) of from 0.1 microns to 5 microns, or from0.1 microns to 2 microns, or from 0.1 microns to 1.5 microns, or from0.1 microns to 1.2 microns, or from 0.1 microns to 1 micron, or from 0.1microns to less than 1 micron, or from 0.1 microns to 0.9 microns, orfrom 0.1 microns to 0.8 microns, or from 0.1 microns to 0.7 microns, orfrom 0.2 microns to 5 microns, or from 0.2 microns to 2 microns, or from0.2 microns to 1.5 microns, or from 0.2 microns to 1.2 microns, or from0.2 microns to 1 micron, or from 0.2 microns to less than 1 micron, orfrom 0.2 microns to 0.9 microns, or from 0.2 microns to 0.8 microns, orfrom 0.2 microns to 0.7 microns, or from 0.3 microns to 5 microns, orfrom 0.3 microns to 2 microns, or from 0.3 microns to 1.5 microns, orfrom 0.3 microns to 1.2 microns, or from 0.3 microns to 1 micron, orfrom 0.3 microns to less than 1 micron, or from 0.3 microns to 0.9microns, or from 0.3 microns to 0.8 microns, or from 0.3 microns to 0.7microns, or from 0.4 microns to 5 microns, or from 0.4 microns to 2microns, or from 0.4 microns to 1.5 microns, or from 0.4 microns to 1.2microns, or from 0.4 microns to 1 micron, or from 0.4 microns to lessthan 1 micron, or from 0.4 microns to 0.9 microns, or from 0.4 micronsto 0.8 microns, or from 0.4 microns to 0.7 microns, or from 0.5 micronsto 5 microns, or from 0.5 microns to 2 microns, or from 0.5 microns to1.5 microns, or from 0.5 microns to 1.2 microns, or from 0.5 microns to1 micron, or from 0.5 microns to less than 1 micron, or from 0.5 micronsto 0.9 microns, or from 0.5 microns to 0.8 microns, or from 0.5 micronsto 0.7 microns, or from 0.6 microns to 5 microns, or from 0.6 microns to2 microns, or from 0.6 microns to 1.5 microns, or from 0.6 microns to1.2 microns, or from 0.6 microns to 1 micron, or from 0.6 microns toless than 1 micron, or from 0.6 microns to 0.9 microns, or from 0.6microns to 0.8 microns, or from 0.6 microns to 0.7 microns. Theantineoplastic particles or taxane particles are in a size range wherethey are unlikely to be carried out of the tumor by systemic circulationand yet benefit from the high specific surface area to provide enhancedsolubilization and release of the drug.

The particle size of the antineoplastic particles including taxaneparticles can be determined by a particle size analyzer instrument andthe measurement is expressed as the mean diameter based on a numberdistribution (number). A suitable particle size analyzer instrument isone which employs the analytical technique of light obscuration, alsoreferred to as photozone or single particle optical sensing (SPOS). Asuitable light obscuration particle size analyzer instrument is theACCUSIZER, such as the ACCUSIZER 780 SIS, available from Particle SizingSystems, Port Richey, Fla. Another suitable particle size analyzerinstrument is one which employs laser diffraction, such as the ShimadzuSALD-7101.

Antineoplastic agent particles including taxane particles can bemanufactured using various particle size-reduction methods and equipmentknown in the art. Such methods include, but are not limited toconventional particle size-reduction methods such as wet or dry milling,micronizing, disintegrating, and pulverizing. Other methods include“precipitation with compressed anti-solvents” (PCA) such as withsupercritical carbon dioxide. In various embodiments, the antineoplasticand/or taxane particles are made by PCA methods as disclosed in USpatents U.S. Pat. Nos. 5,874,029, 5,833,891, 6,113,795, 7,744,923,8,778,181, 9,233,348; US publications US 2015/0375153, US 2016/0354336,US 2016/0374953; and international patent application publications WO2016/197091, WO 2016/197100, and WO 2016/197101; all of which are hereinincorporated by reference.

In PCA particle size reduction methods using supercritical carbondioxide, supercritical carbon dioxide (anti-solvent) and solvent, e.g.acetone or ethanol, are employed to generate uncoated antineoplastic ortaxane particles as small as 0.1 to 5 microns within awell-characterized particle-size distribution. The carbon dioxide andsolvent are removed during processing (up to 0.5% residual solvent mayremain), leaving antineoplastic or taxane particles as a powder.Stability studies show that the paclitaxel particle powder is stable ina vial dose form when stored at room temperature for up to 59 months andunder accelerated conditions (40° C./75% relative humidity) for up tosix months.

Taxane particles produced by various supercritical carbon dioxideparticle size reduction methods can have unique physical characteristicsas compared to taxane particles produced by conventional particle sizereduction methods using physical impacting or grinding, e.g., wet or drymilling, micronizing, disintegrating, comminuting, microfluidizing, orpulverizing. As disclosed in US publication 2016/0374953, hereinincorporated by reference, such unique characteristics include a bulkdensity (not tapped) between 0.05 g/cm³ and 0.15 g/cm³ and a specificsurface area (SSA) of at least 18 m²/g of taxane (e.g., paclitaxel anddocetaxel) particles, which are produced by the supercritical carbondioxide particle size reduction methods described in US publication2016/0374953 and as described below. This bulk density range isgenerally lower than the bulk density of taxane particles produced byconventional means, and the SSA is generally higher than the SSA oftaxane particles produced by conventional means. These uniquecharacteristics result in significant increases in dissolution rates inwater/methanol media as compared to taxanes produced by conventionalmeans. As used herein, the “specific surface area” (SSA) is the totalsurface area of the taxane particle per unit of taxane mass as measuredby the Brunauer-Emmett-Teller (“BET”) isotherm by the following method:a known mass between 200 and 300 mg of the analyte is added to a 30 mLsample tube. The loaded tube is then mounted to a Porous Materials Inc.SORPTOMETER®, model BET-202A. The automated test is then carried outusing the BETWIN® software package and the surface area of each sampleis subsequently calculated. As will be understood by those of skill inthe art, the “taxane particles” can include both agglomerated taxaneparticles and non-agglomerated taxane particles; since the SSA isdetermined on a per gram basis it takes into account both agglomeratedand non-agglomerated taxane particles in the composition. Theagglomerated taxane particles are defined herein as individual taxaneparticles that are formed by the agglomeration of smaller particleswhich fuse together forming the larger individual taxane particles, allof which occurs during the processing of the taxane particles. The BETspecific surface area test procedure is a compendial method included inboth the United States Pharmaceopeia and the European Pharmaceopeia. Thebulk density measurement can be conducted by pouring the taxaneparticles into a graduated cylinder without tapping at room temperature,measuring the mass and volume, and calculating the bulk density.

As disclosed in US publication 2016/0374953, studies showed a SSA of15.0 m²/g and a bulk density of 0.31 g/cm³ for paclitaxel particlesproduced by milling paclitaxel in a Deco-PBM-V-0.41 ball mill suing a 5mm ball size, at 600 RPM for 60 minutes at room temperature. Alsodisclosed in US publication 2016/0374953, one lot of paclitaxelparticles had a SSA of 37.7 m²/g and a bulk density of 0.085 g/cm³ whenproduced by a supercritical carbon dioxide method using the followingmethod: a solution of 65 mg/ml of paclitaxel was prepared in acetone. ABETE MicroWhirl® fog nozzle (BETE Fog Nozzle, Inc.) and a sonic probe(Qsonica, model number Q700) were positioned in the crystallizationchamber approximately 8 mm apart. A stainless steel mesh filter withapproximately 100 nm holes was attached to the crystallization chamberto collect the precipitated paclitaxel particles. The supercriticalcarbon dioxide was placed in the crystallization chamber of themanufacturing equipment and brought to approximately 1200 psi at about38° C. and a flow rate of 24 kg/hour. The sonic probe was adjusted to60% of total output power at a frequency of 20 kHz. The acetone solutioncontaining the paclitaxel was pumped through the nozzle at a flow rateof 4.5 mL/minute for approximately 36 hours. Additional lots ofpaclitaxel particles produced by the supercritical carbon dioxide methoddescribed above had SSA values of: 22.27 m²/g, 23.90 m²/g, 26.19 m²/g,30.02 m²/g, 31.16 m²/g, 31.70 m²/g, 32.59 m²/g, 33.82 m²/g, 35.90 m²/g,38.22 m²/g, and 38.52 m²/g.

As disclosed in US publication 2016/0374953, studies showed a SSA of15.2 m²/g and a bulk density of 0.44 g/cm³ for docetaxel particlesproduced by milling docetaxel in a Deco-PBM-V-0.41 ball mill suing a 5mm ball size, at 600 RPM for 60 minutes at room temperature. Alsodisclosed in US publication 2016/0374953, docetaxel particles had a SSAof 44.2 m²/g and a bulk density of 0.079 g/cm³ when produced by asupercritical carbon dioxide method using the following method: Asolution of 79.32 mg/ml of docetaxel was prepared in ethanol. The nozzleand a sonic probe were positioned in the pressurizable chamberapproximately 9 mm apart. A stainless steel mesh filter withapproximately 100 nm holes was attached to the pressurizable chamber tocollect the precipitated docetaxel particles. The supercritical carbondioxide was placed in the pressurizable chamber of the manufacturingequipment and brought to approximately 1200 psi at about 38° C. and aflow rate of 68 slpm. The sonic probe was adjusted to 60% of totaloutput power at a frequency of 20 kHz. The ethanol solution containingthe docetaxel was pumped through the nozzle at a flow rate of 2mL/minute for approximately 95 minutes). The precipitated docetaxelagglomerated particles and smaller docetaxel particles were thencollected from the supercritical carbon dioxide as the mixture is pumpedthrough the stainless steel mesh filter. The filter containing theparticles of docetaxel was opened and the resulting product wascollected from the filter.

As disclosed in US publication 2016/0374953, dissolution studies showedan increased dissolution rate in methanol/water media of paclitaxel anddocetaxel particles made by the supercritical carbon dioxide methodsdescribed in US publication 2016/0374953 as compared to paclitaxel anddocetaxel particles made by milling paclitaxel and docetaxel using aDeco-PBM-V-0.41 ball mill suing a 5 mm ball size, at 600 RPM for 60minutes at room temperature. The procedures used to determine thedissolution rates are as follows. For paclitaxel, approximately 50 mg ofmaterial were coated on approximately 1.5 grams of 1 mm glass beads bytumbling the material and beads in a vial for approximately 1 hour.Beads were transferred to a stainless steel mesh container and placed inthe dissolution bath containing methanol/water 50/50 (v/v) media at 37°C., pH 7, and a USP Apparatus II (Paddle), operating at 75 rpm. At 10,20, 30, 60, and 90 minutes, a 5 mL aliquot was removed, filtered througha 0.22 μm filter and analyzed on a UV/VIS spectrophotometer at 227 nm.Absorbance values of the samples were compared to those of standardsolutions prepared in dissolution media to determine the amount ofmaterial dissolved. For docetaxel, approximately 50 mg of material wasplaced directly in the dissolution bath containing methanol/water 15/85(v/v) media at 37° C., pH 7, and a USP Apparatus II (Paddle), operatingat 75 rpm. At 5, 15, 30, 60, 120 and 225 minutes, a 5 mL aliquot wasremoved, filtered through a 0.22 μm filter, and analyzed on a UV/VISspectrophotometer at 232 nm. Absorbance values of the samples werecompared to those of standard solutions prepared in dissolution media todetermine the amount of material dissolved. For paclitaxel, thedissolution rate was 47% dissolved in 30 minutes for the particles madeby the supercritical carbon dioxide method versus 32% dissolved in 30minutes for the particles made by milling. For docetaxel, thedissolution rate was 27% dissolved in 30 minutes for the particles madeby the supercritical carbon dioxide method versus 9% dissolved in 30minutes for the particles made by milling.

In some embodiments, the antineoplastic particles have a SSA of at least10, at least 12, at least 14, at least 16, at least 18, at least 19, atleast 20, at least 21, at least 22, at least 23, at least 24, at least25, at least 26, at least 27, at least 28, at least 29, at least 30, atleast 31, at least 32, at least 33, at least 34, or at least 35 m²/g. Inone embodiment, the antineoplastic particles have an SSA of betweenabout 10 m²/g and about 50 m²/g. In some embodiments, the antineoplasticparticles have a bulk density between about 0.050 g/cm³ and about 0.20g/cm³.

In further embodiments, the antineoplastic particles have a SSA of:

-   -   (a) between 16 m²/g and 31 m²/g or between 32 m²/g and 40 m²/g;    -   (b) between 16 m²/g and 30 m²/g or between 32 m²/g and 40 m²/g;    -   (c) between 16 m²/g and 29 m²/g or between 32 m²/g and 40 m²/g;    -   (d) between 17 m²/g and 31 m²/g or between 32 m²/g and 40 m²/g;    -   (e) between 17 m²/g and 30 m²/g or between 32 m²/g and 40 m²/g;    -   (f) between 17 m²/g and 29 m²/g, or between 32 m²/g and 40 m²/g;    -   (g) between 16 m²/g and 31 m²/g or between 33 m²/g and 40 m²/g;    -   (h) between 16 m²/g and 30 m²/g or between 33 m²/g and 40 m²/g;    -   (i) between 16 m²/g and 29 m²/g or between 33 m²/g and 40 m²/g;    -   (j) between 17 m²/g and 31 m²/g or between 33 m²/g and 40 m²/g;    -   (k) between 17 m²/g and 30 m²/g or between 33 m²/g and 40 m²/g;    -   (l) between 17 m²/g and 29 m²/g, or between 33 m²/g and 40 m²/g;    -   (m) between 16 m²/g and 31 m²/g, or ≥32 m²/g;    -   (h) between 17 m²/g and 31 m²/g, or ≥32 m²/g;    -   (i) between 16 m²/g and 30 m²/g, or ≥32 m²/g;    -   (j) between 17 m²/g and 30 m²/g, or ≥32 m²/g;    -   (k) between 16 m²/g and 29 m²/g, or ≥32 m²/g;    -   (l) between 17 m²/g and 29 m²/g, or ≥32 m²/g;    -   (m) between 16 m²/g and 31 m²/g, or ≥33 m²/g;    -   (n) between 17 m²/g and 31 m²/g, or ≥33 m²/g;    -   (o) between 16 m²/g and 30 m²/g, or ≥33 m²/g;    -   (p) between 17 m²/g and 30 m²/g, or ≥33 m²/g;    -   (q) between 16 m²/g and 29 m²/g, or ≥33 m²/g; or    -   (r) between 17 m²/g and 29 m²/g, or ≥33 m²/g.

In some embodiments, the antineoplastic particles are taxane particles.In some embodiments, the antineoplastic particles or taxane particlesare individual taxane particles that are formed by the agglomeration ofsmaller particles which fuse together forming the larger individualtaxane particles, all of which occurs during the processing of thetaxane particles. In some embodiments, the antineoplastic particles ortaxane particles are non-agglomerated individual particles and are notclusters of multiple antineoplastic or taxane particles that are boundtogether by interactive forces such as non-covalent interactions, vander Waal forces, hydrophilic or hydrophobic interactions, electrostaticinteractions, Coulombic forces, interactions with a dispersion material,or interactions via functional groups.

In some embodiments, the taxane particles are paclitaxel particles andhave an SSA of at least 18, at least 19, at least 20, at least 21, atleast 22, at least 23, at least 24, at least 25, at least 26, at least27, at least 28, at least 29, at least 30, at least 31, at least 32, atleast 33, at least 34, or at least 35 m²/g. In other embodiments, thepaclitaxel particles have an SSA of 18 m²/g to 50 m²/g, or 20 m²/g to 50m²/g, or 22 m²/g to 50 m²/g, or 25 m²/g to 50 m2/g, or 26 m²/g to 50m²/g, or 30 m²/g to 50 m²/g, or 35 m²/g to 50 m²/g, or 18 m²/g to 45m2/g, or 20 m²/g to 45 m²/g, or 22 m²/g to 45 m²/g, or 25 m²/g to 45m²/g, or 26 m²/g to 45 m²/g or 30 m²/g to 45 m²/g, or 35 m²/g to 45m²/g, or 18 m²/g to 40 m²/g, or 20 m²/g to 40 m2/g, or 22 m²/g to 40m²/g, or 25 m²/g to 40 m²/g, or 26 m²/g to 40 m²/g, or 30 m²/g to 40m2/g, or 35 m²/g to 40 m²/g.

In some embodiments, the paclitaxel particles have a bulk density(not-tapped) of 0.05 g/cm³ to 0.15 g/cm³, or 0.05 g/cm³ to 0.20 g/cm³.

In some embodiments, the paclitaxel particles have a dissolution rate ofat least 40% w/w dissolved in 30 minutes or less in a solution of 50%methanol/50% water (v/v) in a USP II paddle apparatus operating at 75RPM, at 37° C., and at a pH of 7.

In some embodiments, the taxane particles are docetaxel particles andhave an SSA of at least 18, at least 19, at least 20, at least 21, atleast 22, at least 23, at least 24, at least 25, at least 26, at least27, at least 28, at least 29, at least 30, at least 31, at least 32, atleast 33, at least 34, at least 35, at least 36, at least 37, at least38, at least 39, at least 40, at least 41, or at least 42 m²/g. In otherembodiments, the docetaxel particles have an SSA of 18 m²/g to 60 m²/g,or 22 m²/g to 60 m²/g, or 25 m²/g to 60 m²/g, or 30 m²/g to 60 m²/g, or40 m²/g to 60 m²/g, or 18 m²/g to 50 m²/g, or 22 m²/g to 50 m²/g, or 25m²/g to 50 m²/g, or 26 m²/g to 50 m²/g, or 30 m²/g to 50 m²/g, or 35m²/g to 50 m²/g, or 40 m²/g to 50 m²/g.

In some embodiments, the docetaxel particles have a bulk density(not-tapped) of 0.05 g/cm³ to 0.15 g/cm³.

In some embodiments, the docetaxel particles have a dissolution rate ofat least 20% w/w dissolved in 30 minutes or less in a solution of 15%methanol/85% water (v/v) in a USP II paddle apparatus operating at 75RPM, at 37° C., and at a pH of 7.

II. Compositions for Local Administration

The compositions useful for local administration are compositions thatcomprise the antineoplastic particles, including taxane particles,described herein and throughout this disclosure, and are compositionssuitable for the various types of local administration, i.e. topicalapplication, pulmonary administration, intratumoral (IT) injection, andintraperitoneal (IP) injection. The composition can be a suspension. Forexample, the composition can comprise a carrier wherein theantineoplastic particles are dispersed within the carrier such that thecarrier is a continuous phase and the antineoplastic particles are adispersed (suspended) phase. The antineoplastic particles can becompletely dispersed, or partially dispersed and partially dissolved inthe composition and/or carrier, but the antineoplastic particles cannotbe completely dissolved in the composition and/or carrier.

A. Compositions for Topical Application

The compositions for topical application (topical compositions) compriseantineoplastic particles, such as taxane particles. The antineoplasticparticles can be dispersed (suspended) in the topical composition. Thetopical composition can be any composition suitable for topicaldelivery. The topical composition can be a hydrophobic composition. Thetopical composition can be an anhydrous composition, which can includean anhydrous, hydrophilic composition or an anhydrous, hydrophobiccomposition. Non-limiting examples of anhydrous, hydrophiliccompositions include compositions based on polyols, glycols (e.g.propylene glycol, PEG), and/or poloxamers. The topical composition canbe non-anhydrous, such as an aqueous-based composition. The topicalcompositions can be sterile, can be self-preserved, or can includepreservatives.

The topical compositions can be formulated in various forms suitable fortopical delivery. Non-limiting examples include semi-solid compositions,lotions, liquid suspensions, emulsions, creams, gels, ointments, pastes,aerosol sprays, aerosol foams, non-aerosol sprays, non-aerosol foams,films, and sheets. Semi-solid compositions include ointments, pastes,and creams. The topical compositions can be impregnated in gauzes,bandages, or other skin dressing materials. In some embodiments, thetopical compositions are semi-solid compositions. In some embodiments,the topical compositions are ointments. In other embodiments, thetopical compositions are gels. In still other embodiments, the topicalcompositions are liquid suspensions. In some embodiments, the topicalcompositions are not sprays and are not sprayable.

In some embodiments, the topical compositions are free of/do not includeor contain a polymer/copolymer or biocompatible polymer/copolymer. Insome embodiments, the compositions are free of/do not include or containa protein. In some aspects of the invention, the compositions are freeof/do not include or contain albumin. In some aspects of the invention,the compositions are free of/do not include or contain hyaluronic acid.In some aspects of the invention, the compositions are free of/do notinclude or contain a conjugate of hyaluronic acid and a taxane. In someaspects of the invention, the compositions are free of/do not include orcontain a conjugate of hyaluronic acid and paclitaxel. In some aspectsof the invention, the compositions are free of/do not include or containpoloxamers, polyanions, polycations, modified polyanions, modifiedpolycations, chitosan, chitosan derivatives, metal ions, nanovectors,poly-gamma-glutamic acid (PGA), polyacrylic acid (PAA), alginic acid(ALG), Vitamin E-TPGS, dimethyl isosorbide (DMI), methoxy PEG 350,citric acid, anti-VEGF antibody, ethylcellulose, polystyrene,polyanhydrides, polyhydroxy acids, polyphosphazenes, polyorthoesters,polyesters, polyamides, polysaccharides, polyproteins,styrene-isobutylene-styrene (SIBS), a polyanhydride copolymer,polycaprolactone, polyethylene glycol (PEG), Poly(bis(P-carboxyphenoxy)propane-sebacic acid, poly(d,l-lactic acid) (PLA),poly(d,l-lactic acid-co-glycolic acid) (PLAGA), and/or poly(D, Llactic-co-glycolic acid (PLGA).

The topical compositions can be packaged in any package configurationsuitable for topical products. Non-limiting examples include bottles,bottles with pumps, tottles, tubes (aluminum, plastic or laminated),jars, non-aerosol pump sprayers, aerosol containers, pouches, andpackets. The packages can be configured for single-dose or multiple-doseadministration.

Non-limiting examples of suitable topical compositions are disclosed ininternational patent publication WO 2017/049083, herein incorporated byreference.

1. Hydrophobic Topical Compositions

In some embodiments, the topical composition is a hydrophobiccomposition. For purposes of this disclosure, a hydrophobic compositionis a composition in which the total amount of the hydrophobicconstituents in the composition is greater than the total amount of thenon-hydrophobic constituents in the composition. In some embodiments,the hydrophobic composition is anhydrous. In some embodiments, thehydrophobic composition comprises a hydrophobic carrier.

The hydrophobic carrier can comprise substances from plant, animal,paraffinic, and/or synthetically derived sources. Hydrophobic substancesare generally known as substances that lack an affinity for and repelwater. The hydrophobic carrier can be the continuous phase of thetopical composition and the antineoplastic particles can be thedispersed phase. In various embodiments, the hydrophobic carriers arenon-polar and/or non-volatile. Non-limiting examples of hydrophobiccarriers include fats, butters, greases, waxes, solvents, and oils;mineral oils; vegetable oils; petrolatums; water insoluble organicesters and triglycerides; and fluorinated compounds. The hydrophobiccarriers can also comprise silicone materials. Silicone materials aredefined as compounds based on polydialkylsiloxanes and include polymers,elastomers (crosslinked silicones), and adhesives (branched silicones).Non-limiting examples of silicone materials include dimethicone(polydimethylsiloxane), dimethicone copolyol, cyclomethicone,simethicone, silicone elastomers such as ST-elastomer 10 (DOW CORNING),silicone oils, silicone polymers, volatile silicone fluids, and siliconewaxes. In some embodiments, the hydrophobic carrier does not comprisesilicone materials. Plant derived materials include, but are not limitedto, arachis (peanut) oil, balsam Peru oil, camauba wax, candellila wax,castor oil, hydrogenated castor oil, cocoa butter, coconut oil, cornoil, cotton seed oil, jojoba oil, macadamia seed oil, olive oil, orangeoil, orange wax, palm kernel oil, rapeseed oil, safflower oil, sesameseed oil, shea butter, soybean oil, sunflower seed oil, tea tree oil,vegetable oil, and hydrogenated vegetable oil. Non-limiting examples ofanimal derived materials include beeswax (yellow wax and white wax), codliver oil, emu oil, lard, mink oil, shark liver oil, squalane, squalene,and tallow. Non-limiting examples of paraffinic materials includeisoparaffin, microcrystalline wax, heavy mineral oil, light mineral oil,ozokerite, petrolatum, white petrolatum, and paraffin wax. Non-limitingexamples of organic esters and triglycerides include C12-15 alkylbenzoate, isopropyl myristate, isopropyl palmitate, medium chaintriglycerides, mono- and di-glycerides, trilaurin, andtrihydroxystearin. A non-limiting example of a fluorinated compound isperfluoropolyether (PFPE), such as FOMBLIN®HC04 commercially availablefrom Solvay Specialty Polymers. The hydrophobic carrier can comprisepharmaceutical grade hydrophobic substances.

In various embodiments, the hydrophobic carrier comprises petrolatum,mineral oil, or paraffin, or mixtures thereof. Petrolatum is a purifiedmixture of semi-solid saturated hydrocarbons obtained from petroleum,and varies from dark amber to light yellow in color. White petrolatum iswholly or nearly decolorized and varies from cream to snow white incolor. Petrolatums are available with different melting point,viscosity, and consistency characteristics. Petrolatums may also containa stabilizer such as an antioxidant. Pharmaceutical grades of petrolatuminclude Petrolatum USP and White Petrolatum USP. Mineral oil is amixture of liquid hydrocarbons obtained from petroleum. Mineral oil isavailable in various viscosity grades, such as light mineral oil, heavymineral oil, and extra heavy mineral oil. Light mineral oil has akinematic viscosity of not more than 33.5 centistokes at 40° C. Heavymineral oil has a kinematic viscosity of not less than 34.5 centistokesat 40° C. Pharmaceutical grades of mineral oil include Mineral Oil USP,which is heavy mineral oil, and Light Mineral Oil NF, which is lightmineral oil. In some embodiments, the mineral oil is heavy mineral oil.Paraffin wax is a purified mixture of solid hydrocarbons obtained frompetroleum. It may also be synthetically derived by the Fischer-Tropschprocess from carbon monoxide and hydrogen which are catalyticallyconverted to a mixture of paraffin hydrocarbons. Paraffin wax maycontain an antioxidant. Pharmaceutical grades of paraffin wax includeParaffin NF and Synthetic Paraffin NF.

In some embodiments, the concentration of the hydrophobic carrier in thehydrophobic composition is greater than 10% w/w of the total compositionweight. In other embodiments, the concentration of the hydrophobiccarrier in the hydrophobic composition is greater than 15%, or greaterthan 20%, or greater than 25%, or greater than 30%, or greater than 35%,or greater than 40%, or greater than 45%, or greater than 50%, orgreater than 55%, or greater than 60%, or greater than 65%, or greaterthan 70%, or greater than 75%, or greater than 80%, or greater than 82%,or greater than 85%, or greater than 87%, or greater than 90% w/w of thetotal composition weight. In other embodiments, the concentration of thehydrophobic carrier in the hydrophobic composition is from greater than10% w/w to 95% w/w of the total composition weight. In otherembodiments, the concentration of the hydrophobic carrier in thehydrophobic composition is from 11% w/w to 95% w/w, or from 12% w/w to95% w/w, or from 13% w/w to 95% w/w, or from 14% w/w to 95% w/w, or from15% w/w to 95% w/w, or from 16% w/w to 95% w/w, or from 17% w/w to 95%w/w, or from 18% w/w to 95% w/w, or from 19% w/w to 95% w/w, or from 20%w/w to 95% w/w of the total composition weight. In a preferredembodiment, the hydrophobic carrier in the hydrophobic composition isgreater than 50% of the hydrophobic composition.

The hydrophobic composition can comprise a hydrophobic carrier andfurther comprise one or more volatile silicone fluids. Volatile siliconefluids, also known as volatile silicone oils, are volatile liquidpolysiloxanes which can by cyclic or linear. They are liquid at roomtemperature. Volatile silicone fluids are hydrophobic materials. Linearvolatile silicone fluids include poly dimethylsiloxane,hexamethyldisiloxane and octamethyltrisiloxane and are commerciallyavailable from Dow Corning under the trade names DOW CORNING Q7-9180Silicone Fluid 0.65 cSt and DOW CORNING Q7-9180 Silicone Fluid 1.0 cSt,respectively. Cyclic volatile silicone fluids are generally known ascyclomethicones. Cyclomethicone is a fully methylated cyclic siloxanecontaining repeating units of formula (IV):

[—(CH₃)₂SiO—]_(n)  (IV)

in which n is 3, 4, 5, 6, or 7; or mixtures thereof. Cyclomethicone is aclear, colorless volatile liquid silicone fluid. Cyclomethicone hasemollient properties and helps to improve the tactile feel of an oilbased product by making it feel less greasy on the skin. Pharmaceuticalgrade cyclomethicone includes Cyclomethicone NF. Cyclomethicone NF isrepresented by formula (IV) in which n is 4 (cyclotetrasiloxane), 5(cyclopentasiloxane), or 6 (cyclohexasiloxane); or mixtures thereof.Cyclopentasiloxane, also known as decamethylcylcopentasiloxane,cyclomethicone D5, or cyclomethicone 5, is the cyclomethiconerepresented by formula (IV) in which n is 5 (pentamer), but it cancontain small amounts (generally less than 1%) of one or more of theother cyclic chain length cyclomethicones. Cyclopentasiloxane isavailable in a pharmaceutical grade as Cyclomethicone NF.Cyclomethicones are commercially available from Dow Corning under thetrade names DOW CORNING ST-Cyclomethicone 5-NF, DOW CORNINGST-Cyclomethicone 56-NF, and XIAMETER PMX-0245. It is also commerciallyavailable from the Spectrum Chemical Mfg. Corp. Cyclopentasiloxane has avapor pressure of about 20 to about 27 Pa at 25° C.

In one embodiment, the concentration of cyclomethicone in thehydrophobic composition is less than 25% w/w. In another embodiment, thecyclomethicone in the hydrophobic composition is at a concentration from5 to 24% w/w. In another embodiment, the concentration of cyclomethiconeis from 5 to 20% w/w. In another embodiment, the cyclomethicone is at aconcentration of from 5 to 18% w/w. In another embodiment, theconcentration of cyclomethicone is 13% w/w. In various embodiments, theconcentration of cyclomethicone can be 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5,9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16,16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23,23.5, or 24% w/w or any percentage derivable therein of the totalcomposition weight. In some embodiments, the volatile silicone fluid isa cyclomethicone. In some embodiments, the cyclomethicone iscyclopentasiloxane.

The hydrophobic composition can be a suspension of the antineoplasticparticles, such as taxane particles, within a mixture of the hydrophobiccarrier and the volatile silicone fluid. The antineoplastic particlescan be completely dispersed, or partially dispersed and partiallydissolved in the hydrophobic composition, but the antineoplasticparticles cannot be completely dissolved in the hydrophobic composition.The hydrophobic carrier can be the continuous phase of the hydrophobiccomposition and the antineoplastic particles can be the dispersed phase.Therefore, the hydrophobic compositions can include at least two phases,a continuous hydrophobic carrier phase and a dispersed (suspended)antineoplastic particle phase. The volatile silicone fluid can besolubilized and/or dispersed within the continuous phase.

In some embodiments, the hydrophobic compositions are free of/do notinclude or contain additional penetration enhancers. In someembodiments, the hydrophobic compositions are free of/do not include orcontain laurocapram. In some embodiments, the hydrophobic compositionsare free of/do not include diethylene glycol monoethyl ether (DGME). Insome embodiments, the hydrophobic compositions are free of/do notinclude isopropyl myristate. In other embodiments, the hydrophobiccompositions are free of/do not include alpha tocopherol. In otherembodiments, the hydrophobic compositions are free of/do not include orcontain additional volatile solvents or compounds. In some embodiments,the hydrophobic compositions are free of/do not include or contain anyalcohols or C₁-C₄ aliphatic alcohols. In some embodiments, thehydrophobic compositions are free of/do not include or contain alcoholor C₁-C₅ aliphatic alcohols. In other embodiments, the hydrophobiccompositions are free of/do not include or contain surfactants. In otherembodiments, the hydrophobic compositions are free of/do not includepolymers/copolymers (or biodegradable polymers/copolymers). In otherembodiments, the hydrophobic compositions are free of/do not includepoloxamers, styrene-isobutylene-styrene (SIBS), a polyanhydridecopolymer, polycaprolactone, polyethylene glycol, Poly(bis(P-carboxyphenoxy)propane-sebacic acid, and/or poly(D, Llactic-co-glycolic acid (PLGA).

In some embodiments, the hydrophobic compositions are semi-solidcompositions. In some embodiments, the hydrophobic compositions areointments. In some embodiments, the hydrophobic compositions aresemi-solid compositions, including ointments, and have a viscosity offrom 12,500 cps to 247,500 cps, or from 25,000 cps to 150,000 cps asmeasured at room temperature by a Brookfield RV viscometer using a smallsample adapter with a SC4-14 spindle and a 6R chamber at 5 rpm with anequilibration time of 2 minutes. An alternative method for performingviscosity measurements of the hydrophobic, semi-solid compositions isusing a Brookfield RV viscometer on a helipath stand with the helipathon, with a T-E spindle at 10 RPM at room temperature for 45 seconds. Insome embodiments, the hydrophobic compositions are semi-solidcompositions, including ointments, and have a viscosity of from 25,000cps to 500,000 cps, or from 25,000 cps to 400,000 cps, or from 25,000cps to 350,000 cps, or from 25,000 cps to 300,000 cps, or from 50,000cps to 500,000 cps, or from 50,000 cps to 400,000 cps, or from 50,000cps to 350,000 cps, or from 50,000 cps to 300,000 cps, or from 75,000cps to 500,000 cps, or from 75,000 cps to 400,000 cps, or from 75,000cps to 350,000 cps, or from 75,000 cps to 300,000 cps, or from 100,000cps to 500,000 cps, or from 100,000 cps to 400,000 cps, or from 100,000cps to 350,000 cps, or from 100,000 cps to 300,000 cps using aBrookfield RV viscometer on a helipath stand with the helipath on, witha T-E spindle at 10 RPM at room temperature for 45 seconds.

2. Aqueous-Based Topical Compositions

Topical aqueous-based compositions comprise antineoplastic particles,such as taxane particles, and an aqueous carrier. The aqueouscompositions are dispersions (suspensions) of the antineoplasticparticles in an aqueous carrier. The antineoplastic particles can becompletely dispersed, partially dispersed and partially dissolved, butnot completely dissolved in the aqueous carrier. An aqueous-basedcomposition is a composition in which water is the major constituent(greater than 50%). Aqueous carriers can include single phase aqueoussolutions, and multi-phase aqueous-based emulsions such as oil-in-waterand water-in-oil emulsions. Non-limiting examples of aqueous carriersinclude water and buffer solutions.

A non-limiting example of a topical aqueous-based composition comprisesan aqueous carrier (e.g. water) comprising poloxamer 407, a quaternaryammonium compound, and/or or a cross-linked acrylic acid polymer, asdisclosed in international patent publication WO 2017/049083.Non-limiting examples of a quaternary ammonium compound includebenzalkonium chloride and benzethonium chloride. Non-limiting examplesof cross-linked acrylic acid polymers include Carbomer (INCI name),Acrylates Copolymer (INCI name), Acrylates/C 10-30 Alkyl AcrylateCrosspolymer (INCI name), Acrylates Crosspolymer-4 (INCI name), andPolyacrylate-1 Crosspolymer (INCI name).

3. Additional Ingredients and Excipients for Topical Compositions

The topical compositions can further comprise functional ingredientssuitable for use in topical compositions. Non-limiting examples includeabsorbents, acidifying agents, antimicrobial agents, antioxidants,binders, biocides, buffering agents, bulking agents, crystal growthinhibitors, chelating agents, colorants, deodorant agents, emulsionstabilizers, film formers, fragrances, humectants, lytic agents,enzymatic agents, opacifying agents, oxidizing agents, pH adjusters,plasticizers, preservatives, reducing agents, emollient skinconditioning agents, humectant skin conditioning agents, moisturizers,surfactants, emulsifying agents, cleansing agents, foaming agents,hydrotopes, solvents, suspending agents, viscosity control agents(rheology modifiers), viscosity increasing agents (thickeners), andpropellants. Listings and monographs of the examples of the functionalingredients described herein are disclosed in The International CosmeticIngredient Dictionary and Handbook (INCI), 12^(th) Edition, 2008, hereinincorporated by reference.

In some embodiments, the topical compositions comprise penetrationenhancers. In other embodiments, the topical compositions are free of/donot include additional penetration enhancers. The term “penetrationenhancer” has been used to describe compounds or materials or substancesthat facilitate drug absorption through the skin. These compounds ormaterials or substances can have a direct effect on the permeability ofthe skin, or they can augment percutaneous absorption by increasing thethermodynamic activity of the penetrant, thereby increasing theeffective escaping tendency and concentration gradient of the diffusingspecies. The predominant effect of these enhancers is to either increasethe stratum corneum's degree of hydration or disrupt its lipoproteinmatrix, the net result in either case being a decrease in resistance todrug (penetrant) diffusion (Remington, The Science and Practice ofPharmacy, 22^(nd) ed.). Non-limiting examples of skin penetrationenhancers include oleyl alcohol, isopropyl myristate, dimethylisosorbide (DMI) available under the tradename ARLASOLVE DMI, andDiethylene Glycol Monoethyl Ether (DGME) which is available under thetrade name TRANSCUTOL P. Other examples of skin penetration enhancerscan be found in “Skin Penetration Enhancers Cited in the TechnicalLiterature”, Osborne, David W., and Henke, Jill J., PharmaceuticalTechnology, November 1997, herein incorporated by reference. Suchexamples include: Fatty alcohols such as aliphatic alcohols, Decanol,Lauryl alcohol (dodecanol), Linolenyl alcohol, Nerolidol, 1-Nonanol,n-Octanol, Oleyl alcohol, Fatty acid esters, Butylacetate, Cetyllactate, Decyl N,N-dimethylamino acetate, Decyl N,N-dimethylaminoisopropionate, Diethyleneglycol oleate, Diethyl sebacate, Diethylsuccinate, Diisopropyl sebacate, Dodecyl N,N-dimethylamino acetate,Dodecyl (N,N-dimethylamino)-butyrate, Dodecyl N,N-dimethylaminoisopropionate, Dodecyl 2-(dimethylamino) propionate, EO-5-oleyl ester,Ethyl acetate, Ethylaceto acetate, Ethyl propionate, Glycerolmonoethers, Glycerol monolaurate, Glycerol monooleate, Glycerolmonolinoleate, Isopropyl isostearate, Isopropyl linoleate, Isopropylmyristate, Isopropyl myristate/fatty acid monoglyceride combination,Isopropyl myristate/ethanol/L-lactic acid (87:10:3) combination,Isopropyl palmitate, Methyl acetate, Methyl caprate, Methyl laurate,Methyl propionate, Methyl valerate, 1-Monocaproyl glycerol,Monoglycerides (medium chain length), Nicotinic esters (benzyl), Octylacetate, Octyl N,N-dimethylamino acetate, Oleyl oleate, n-PentylN-acetylprolinate, Propylene glycol monolaurate, Sorbitan dilaurate,Sorbitan dioleate, Sorbitan monolaurate, Sorbitan monooleates, Sorbitantrilaurate, Sorbitan trioleate, Sucrose coconut fatty ester mixtures,Sucrose monolaurate, Sucrose monooleate, and TetradecylN,N-dimethylamino acetate; Fatty acids such as Alkanoic acids, Capricacid, Diacid, Ethyloctadecanoic acid, Hexanoic acid, Lactic acid, Lauricacid, Linoelaidic acid, Linoleic acid, Linolenic acid, Neodecanoic acid,Oleic acid, Palmitic acid, Pelargonic acid, Propionic acid, and Vaccenicacid; Fatty alcohol ethers such as α-Monoglyceryl ether, EO-2-oleylether, EO-5-oleyl ether, EO-10-oleyl ether, and Ether derivatives ofpolyglycerols and alcohols (1-O-dodecyl-3-O-methyl-2-O-(2′,3′-dihydroxypropyl) glycerol); Biologics such as L-α-amino-acids,Lecithin, Phospholipids, Saponin/phospholipids, Sodium deoxycholate,Sodium taurocholate, and Sodium tauroglycocholate; Enzymes such as Acidphosphatase, Calonase, Orgelase, Papain, Phospholipase A-2,Phospholipase C, and Triacylglycerol hydrolase; Amines and Amides suchas Acetamide derivatives, Acyclic amides, N-Adamantyl n-alkanamides,Clofibric acid amides, N,N-Didodecyl acetamide, Di-2-ethylhexylamine,Diethyl methyl benzamide, N,N-Diethyl-m-toluamide,N,N-Dimethyl-m-toluarnide, Ethomeen S12 [bis-(2-hydroxyethyl)oleylamine], Hexamethylene lauramide, Lauryl-amine (dodecylamine), Octylamide, Oleylamine, Unsaturated cyclic ureas, and Urea; Complexing Agentssuch as, β- and γ-cyclodextrin complexes, Hydroxypropyl methylcellulose,Liposomes, Naphthalene diamide diimide, and Naphthalene diester diimide;Macrocyclics such as Macrocyclic lactones, ketones, and anhydrides(optimum ring-16), and Unsaturated cyclic ureas; Classical surfactantssuch as Brij 30, Brij 35, Brij 36T, Brij 52, Brij 56, Brij 58, Brij 72,Brij 76, Brij 78, Brij 92, Brij 96, Brij 98, Cetyl trimethyl ammoniumbromide, Empicol ML26/F, HCO-60 surfactant, Hydroxypolyethoxydodecane,Ionic surfactants (ROONa, ROSO₃Na, RNH₃Cl, R=8-16), Lauroyl sarcosine,Nonionic surface active agents, Nonoxynol, Octoxynol, PhenylsulfonateCA, Pluronic F68, Pluronic F 127, Pluronic L62, Polyoleates (nonionicsurfactants), Rewopal HV 10, Sodium laurate, Sodium lauryl sulfate(sodium dodecyl sulfate), Sodium oleate, Sorbitan dilaurate, Sorbitandioleate, Sorbitan monolaurate, Sorbitan monooleates, Sorbitantrilaurate, Sorbitan trioleate, Span 20, Span 40, Span 85, SynperonicNP, Triton X-100, Tween 20, Tween 40, Tween 60, Tween 80, and Tween 85;N-methyl pyrrolidone and related compounds such asN-Cyclohexyl-2-pyrrolidone, l-Butyl-3-dodecyl-2-pyrrolidone,1,3-Dimethyl-2-imidazolikinone, 1,5 Dimethyl-2-pyrrolidone,4,4-Dimethyl-2-undecyl-2-oxazoline, 1-Ethyl-2-pyrrolidone,1-Hexyl-4-methyloxycarbonyl-2-pyrrolidone, 1-Hexyl-2-pyrrolidone,1-(2-Hydroxyethyl) pyrrolidinone, 3-Hydroxy-N-methyl-2-pyrrolidinone,1-Isopropyl-2-undecyl-2-imidazoline,1-Lauryl-4-methyloxycarbonyl-2-pyrrolidone, N-Methyl-2-pyrrolidone,Poly(N-vinylpyrrolidone), Pyroglutamic acid esters, and 2-Pyrrolidone(2-pyrrolidinone); Ionic compounds such as Ascorbate, Amphoteric cationsand anions, Calcium thioglycolate, Cetyl trimethyl ammonium bromide,3,5-Diiodosalicylate sodium, Lauroylcholine iodide, 5-Methoxysalicylatesodium, Monoalkyl phosphates, 2-PAM chloride, 4-PAM chloride(derivatives of N-methyl picolinium chloride), Sodium carboxylate, andSodium hyaluronate; Dimethyl sulfoxide and related compounds such asCyclic sulfoxides, Decylmethyl sulfoxide, Dimethyl sulfoxide (DMSO), and2-Hydroxyundecyl methyl sulfoxide; Solvents and related compounds suchas Acetone, n-Alkanes (chain length between 7 and 16),Cyclohexyl-1,1-dimethylethanol, Dimethylacetamide, Dimethyl formamide,Ethanol, Ethanol/d-limonene combination, 2-Ethyl-1,3-hexanediol,Ethoxydiglycol (TRANSCUTOL), Glycerol, Glycols, Lauryl chloride,Limonene, N-Methylformamide, 2-Phenylethanol, 3-Phenyl-1-propanol,3-Phenyl-2-propen-1-ol, Polyethylene glycol, Polyoxyethylene sorbitanmonoesters, Polypropylene glycol, Primary alcohols (tridecanol),Propylene glycol, Squalene, Triacetin, Trichloroethanol,Trifluoroethanol, Trimethylene glycol, and Xylene; Azone and relatedcompounds such as N-Acyl-hexahydro-2-oxo-1H-azepines,N-Alkyl-dihydro-1,4-oxazepine-5,7-diones, N-Alkylmorpholine-2,3-diones,N-Alkylmorpholine-3,5-diones, Azacycloalkane derivatives (-ketone,-thione), Azacycloalkenone derivatives,1-[2-(Decylthio)ethyl]azacyclopentan-2-one (HPE-101),N-(2,2-Dihydroxyethyl)dodecylamine, 1-Dodecanoylhexahydro-1-H-azepine,1-Dodecyl azacycloheptan-2-one (AZONE or laurocapram), N-Dodecyldiethanolamine, N-Dodecyl-hexahydro-2-thio-1H-azepine,N-Dodecyl-N-(2-methoxyethyl)acetamide, N-Dodecyl-N-(2-methoxyethyl)isobutyramide, N-Dodecyl-piperidine-2-thione, N-Dodecyl-2-piperidinone,N-Dodecyl pyrrolidine-3,5-dione, N-Dodecyl pyrrolidine-2-thione,N-Dodecyl-2-pyrrolidone, 1-Famesylazacycloheptan-2-one,1-Famesylazacyclopentan-2-one, 1-Geranylazacycloheptan-2-one,1-Geranylazacyclopentan-2-one, Hexahydro-2-oxo-azepine-1-acetic acidesters, N-(2-Hydroxyethyl)-2-pyrrolidone, 1-Laurylazacycloheptane,2-(1-Nonyl)-1,3-dioxolane, 1-N-Octylazacyclopentan-2-one,N-(1-Oxododecyl)-hexahydro-1H-azepine, N-(1-Oxododecyl)-morpholines,1-Oxohydrocarbyl-substituted azacyclohexanes,N-(1-Oxotetradecyl)-hexahydro-2-oxo-1H-azepine, andN-(1-Thiododecyl)-morpholines; and others such as Aliphatic thiols,Alkyl N,N-dialkyl-substituted amino acetates, Anise oil, Anticholinergicagent pretreatment, Ascaridole, Biphasic group derivatives, Bisabolol,Cardamom oil, 1-Carvone, Chenopodium (70% ascaridole), Chenopodium oil,1,8 Cineole (eucalyptol), Cod liver oil (fatty acid extract),4-Decyloxazolidin-2-one, Dicyclohexylmethylamine oxide, Diethylhexadecylphosphonate, Diethyl hexadecylphosphoramidate, N,N-Dimethyldodecylamine-N-oxide, 4, 4-Dimethyl-2-undecyl-2-oxazoline,N-Dodecanoyl-L-amino acid methyl esters, 1,3-Dioxacycloalkanes (SEPAs),Dithiothreitol, Eucalyptol (cineole), Eucalyptus oil, Eugenol, Herbalextracts, Lactam N-acetic acid esters, N-Hydroxyethalaceamide,N-Hydroxyethylacetamide, 2-Hydroxy-3-oleoyloxy-1-pyroglutamyloxypropane,Menthol, Menthone, Morpholine derivatives, N-Oxide, Nerolidol,Octyl-β-D-(thio)glucopyranosides, Oxazolidinones, Piperazinederivatives, Polar lipids, Poly dimethylsiloxanes, Poly[2-(methylsulfinyl)ethyl acrylate], Polyrotaxanes,Polyvinylbenzyldimethylalkylammonium chloride, Poly(N-vinyl-N-methylacetamide), Sodium pyroglutaminate, Terpenes and azacyclo ringcompounds, Vitamin E (α-tocopherol), Vitamin E TPGS and Ylang-ylang oil.Additional examples of penetration enhancers not listed above can befound in “Handbook of Pharmaceutical Excipients”, Fifth edition, andinclude glycofurol, lanolin, light mineral oil, myristic acid,polyoxyethylene alky ethers, and thymol. Other examples of penetrationenhancers include ethanolamine, diethanolamine, triethanolamine,diethylene glycol, monoethyl ether, citric acid, succinic acid, borageoil, tetrahydropiperine (THP), methanol, ethanol, propanol, octanol,benzyl alcohol, myristyl alcohol, cetyl alcohol, stearyl alcohol, andpolyethylene glycol monolaurate.

In some embodiments, the topical compositions comprise alcohols, C₁-C₄aliphatic alcohols, and/or C₁-C₅ aliphatic alcohols. In otherembodiments, the topical compositions are free of/do not include orcontain C₁-C₄ aliphatic alcohols, and/or C₁-C₅ aliphatic alcohols. Insome embodiments, the topical compositions comprise volatile solvents.In other embodiments, the topical compositions are free of/do notinclude volatile solvents. Volatile solvents are also known as“fugitive” solvents. Non-limiting examples of volatile solvents includevolatile alcohols, such as C₁ to C₄ aliphatic alcohols; C₁ to C₅alcohols; and volatile C₁ to C₄ aliphatic ketones, such as acetone.

In some embodiments, the topical compositions comprise surfactants. Inother embodiments, the topical compositions are free of/do not includesurfactants. The term “surfactant” or “surface active agent” means acompound or material or substance that exhibits the ability to lower thesurface tension of water or to reduce the interfacial tension betweentwo immiscible substances and includes anionic, cationic, nonionic,amphoteric, and/or phospholipid surfactants. Non-limiting examples ofsurfactants can be found in McCutcheon's Emulsifiers & Detergents, 2001North American Edition herein incorporated by reference and also in theInternational Cosmetic Ingredient Dictionary and Handbook (INCI), 12thEdition, 2008, herein incorporated by reference. Such examples include,but are not limited to, the following: block polymers, e.g., Poloxamer124; ethoxylated alcohols e.g., Ceteth-2, Ceteareth-20, Laureth-3;ethoxylated fatty esters and oils, e.g., PEG-40 Hydrogenated Castor Oil,PEG-36 Castor Oil, PEG-150 Distearate; glycerol esters, e.g.,Polyglyceryl-3 Diisostearate, Glyceryl Stearate; glycol esters, PEG-12Dioleate, LEXEMUL P; phosphate esters, e.g., Cetyl Phosphate; polymericsurfactants, e.g., PVM/MA Copolymer, Acrylates/C10-30 Alkyl AcrylateCrosspolymer; quaternary surfactants, e.g., Cetrimonium Chloride;Silicone Based Surfactants, e.g., PEG/PPG-20/6 Dimethicone; SorbitanDerivatives, e.g., Sorbitan Stearate, Polysorbate 80; sucrose andglucose esters and derivatives, e.g., PEG-20 Methyl GlucoseSesquistearate; and sulfates of alcohols, e.g., Sodium Lauryl Sulfate.More generally, surfactants can be classified by their ionic type suchas anionic, cationic, nonionic, or amphoteric. They can also beclassified by their chemical structures, such as block polymers,ethoxylated alcohols, ethoxylated fatty esters and oils, glycerolesters, glycol esters, phosphate esters, polymeric surfactants,quaternary surfactants, silicone-based surfactants, sorbitanderivatives, sucrose and glucose esters and derivatives, and sulfates ofalcohols.

In some embodiments, the topical compositions comprise proteins, such asalbumin. In other embodiments, the topical compositions are free of/donot include proteins, such as albumin.

In a preferred embodiment, the topical composition is a hydrophobiccomposition comprising a hydrophobic carrier, one or more volatilesilicone fluids, and taxane particles, wherein the mean particle size(number) of the taxane particles is from 0.1 microns to 1.5 microns. Infurther preferred embodiments, the hydrophobic carrier comprisespetrolatum, mineral oil, or paraffin wax, or mixtures thereof. Infurther preferred embodiments, the one or more volatile silicone fluidis cyclomethicone at a concentration of from 5 to 25% w/w of thecomposition. In further preferred embodiments, the taxane particles arepaclitaxel particles.

4. Concentration of Antineoplastic Particles in Topical Compositions

The concentration or amount of the antineoplastic particles in thetopical composition is at an “effective amount” to (1) stimulate animmunological response to the immunotherapeutic agent in the subject,and (2) treat the tumor(s) of the subject, i.e., to provide atherapeutic effect on the tumor by accomplishing one or more of thefollowing: (a) reducing tumor size; (b) reducing tumor growth rate; (c)eliminating the tumor. The concentration of the antineoplasticparticles, which can be taxane particles, can be from 0.05 to 10% w/w,or the concentration of the antineoplastic particles can be from 0.05 to5% w/w, or the concentration of the antineoplastic particles can be from0.1 to 5% w/w, or the concentration of the antineoplastic particles canbe 0.05, 0.1, 0.15, 0.2, 0.25, 0.3, 0.4, 0.5, 0.6, 0.7, 0.75, 0.8, 0.9,1.0, 1.1, 1.2, 1.25, 1.3, 1.4, 1.5, 1.6, 1.7, 1.75, 1.8, 1.9, 2.0, 2.1,2.2, 2.25, 2.3, 2.4, 2.5, 2.6, 2.7, 2.75, 2.8, 2.9, 3.0, 3.1, 3.2, 3.25,3.3, 3.4, 3.5, 3.6, 3.7, 3.75, 3.8, 3.9, 4.0, 4.1, 4.2, 4.25, 4.3, 4.4,4.5, 4.6, 4.7, 4.75, 4.8, 4.9, 5, 6, 7, 8, 9, or 10% w/w or anypercentage derivable therein of the total composition weight. In someembodiments, the antineoplastic particles are taxane particles, such aspaclitaxel nanoparticles, docetaxel nanoparticles, or cabazitaxelnanoparticles. In some embodiments, the taxane particles are paclitaxelparticles. In some embodiments, the taxane particles are at aconcentration of about 0.05 to less than 3% w/w, or about 0.05 to about2% w/w, or about 0.05 to about 1% w/w, or about 0.05 to about 0.3% w/w,or about 0.05 to about 0.2% w/w, or about 0.05 to about 0.15% w/w, orabout 0.1 to about 2% w/w, or about 0.1 to about 1% w/w, or about 0.1 toabout 0.3% w/w, or about 0.1 to about 0.2% w/w, or about 0.15 to about2% w/w, or about 0.15 to about 1% w/w, or about 0.15 to about 0.3% w/w,or about 0.3 to about 2% w/w, or about 0.3 to about 1% w/w, or about 1to about 2% w/w, or about 0.2 to about 0.4% w/w, or about 0.5 to about1.5% w/w, or about 1.5 to about 2.5% w/w in the compositions. In otherembodiments, the concentration of the taxane particles is 80 to 120% of1% w/w (i.e., 0.8 to 1.2% w/w), or 80 to 120% of 0.05% w/w, or 80 to120% of 0.1% w/w, or 80 to 120% of 0.15% w/w, or 80 to 120% of 0.2% w/w,or 80 to 120% of 0.25% w/w, or 80 to 120% of 0.3% w/w, or 80 to 120% of0.35% w/w, or 80 to 120% of 0.4% w/w, or 80 to 120% of 0.45% w/w, or 80to 120% of 0.5% w/w, or 80 to 120% of 0.55% w/w, or 80 to 120% of 0.6%w/w, or 80 to 120% of 0.65% w/w, or 80 to 120% of 0.7% w/w, or 80 to120% of 0.75% w/w, or 80 to 120% of 0.8% w/w, or 80 to 120% of 0.85%w/w, or 80 to 120% of 0.9% w/w, or 80 to 120% of 0.95% w/w, or 80 to120% of 1.5% w/w, or 80 to 120% of 2% w/w, or 80 to 120% of 2.5% w/w.

B. Compositions for Pulmonary Administration, Intratumoral (IT)Injection and/or Intraperitoneal (IP) Injection

The compositions suitable for pulmonary administration, intratumoral(IT) injection and/or intraperitoneal (IP) injection compriseantineoplastic particles, such as taxane particles and are describedbelow. The compositions can further comprise a carrier. The compositionscan be anhydrous and include an anhydrous carrier. The carrier can be aliquid (fluid) carrier, such as an aqueous carrier. Non-limitingexamples of suitable aqueous carriers include water, such as SterileWater for Injection USP; 0.9% saline solution (normal saline), such as0.9% Sodium Chloride for Injection USP; dextrose solution, such as 5%Dextrose for Injection USP; and Lactated Ringer's Solution for InjectionUSP. Non-aqueous based liquid carriers and other aqueous-based liquidcarriers can be used. The carrier can be a pharmaceutically acceptablecarrier, i.e., suitable for administration to a subject by injection,pulmonary route, or other routes of administration. The carrier can beany other type of liquid such as emulsions or flowable semi-solids.Non-limiting examples of flowable semisolids include gels andthermosetting gels. The composition can be a suspension, i.e., asuspension dosage form composition where the antineoplastic particles,such as taxane particles, are dispersed (suspended) within a continuouscarrier/and or diluent. The antineoplastic particles can be completelydispersed, partially dispersed and partially dissolved, but notcompletely dissolved in the carrier. In some embodiments, thecomposition is a suspension of taxane particles dispersed within acontinuous carrier. In a preferred embodiment, the carrier is apharmaceutically acceptable carrier. In preferred embodiments, thecomposition is sterile. In various embodiments, the compositioncomprises, consists essentially of, or consists of antineoplasticparticles and a liquid carrier, wherein the composition is a suspensionof the antineoplastic particles dispersed within the liquid carrier. Insome embodiments, the composition consists essentially of or consists ofantineoplastic particles and a carrier, wherein the carrier is anaqueous carrier and wherein the composition is a suspension.

The composition of antineoplastic particles and a carrier can beadministered as-is. Optionally, the composition of antineoplasticparticles and a carrier can further comprise a suitable diluent todilute the composition in order to achieve a desired concentration(dose) of antineoplastic particles. In some embodiments, the carrier canserve as the diluent; stated another way, the amount of carrier in thecomposition provides the desired concentration of antineoplasticparticles in the composition and no further dilution is needed. Asuitable diluent can be a fluid, such as an aqueous fluid. Non-limitingexamples of suitable aqueous diluents include water, such as SterileWater for Injection USP; 0.9% saline solution (normal saline), such as0.9% Sodium Chloride for Injection USP; dextrose solution, such as 5%Dextrose for Injection USP; and Lactated Ringer's Solution for InjectionUSP. Other liquid and aqueous-based diluents suitable for administrationby injection can be used and can optionally include salts, bufferingagents, and/or other excipients. In preferred embodiments, the diluentis sterile. The composition can be diluted with the diluent at a ratioto provide a desired concentration dosage of the antineoplasticparticles. For example, the volume ratio of composition to diluent mightbe in the range of 1:1-1:100 v/v or other suitable ratios. In someembodiments, the composition comprises antineoplastic particles, acarrier, and a diluent, wherein the carrier and diluent form a mixture,and wherein the composition is a suspension of antineoplastic particlesdispersed in the carrier/diluent mixture. In some embodiments, thecarrier/diluent mixture is a continuous phase and the antineoplasticparticles are a dispersed phase.

The composition, carrier, and/or diluent can further comprise functionalingredients such as buffers, salts, osmotic agents, surfactants,viscosity modifiers, rheology modifiers, suspending agents, pH adjustingagents such as alkalinizing agents or acidifying agents, tonicityadjusting agents, preservatives, antimicrobial agents includingquaternary ammonium compounds such as benzalkonium chloride andbenzethonium chloride, demulcents, antioxidants, antifoaming agents,chelating agents, and/or colorants. For example, the composition cancomprise taxane particles and a carrier comprising water, a salt, asurfactant, and optionally a buffer. In one embodiment, the carrier isan aqueous carrier and comprises a surfactant, wherein the concentrationof the surfactant is 1% or less on a w/w or w/v basis; in otherembodiments, the surfactant is less than 0.5%, less than 0.25%, lessthan 0.1%, or about 0.1%. In other embodiments, the aqueous carrierexcludes the surfactants GELUCIRE® (polyethylene glycol glyceridescomposed of mono-, di- and triglycerides and mono- and diesters ofpolyethylene glycol) and/or CREMOPHOR® (polyethoxylated castor oil). Insome embodiments, the composition or carrier excludes polymers, proteins(such as albumin), polyethoxylated castor oil, and/or polyethyleneglycol glycerides composed of mono-, di- and triglycerides and mono- anddiesters of polyethylene glycol.

The composition, carrier, and/or diluent can comprise one or moresurfactants. Suitable surfactants include by way of example and withoutlimitation polysorbates, lauryl sulfates, acetylated monoglycerides,diacetylated monoglycerides, and poloxamers, such as poloxamer 407.Polysorbates are polyoxyethylene sorbitan fatty acid esters which are aseries of partial fatty acid esters of sorbitol and its anhydridescopolymerized with approximately 20, 5, or 4 moles of ethylene oxide foreach mole of sorbitol and its anhydrides. Non-limiting examples ofpolysorbates are polysorbate 20, polysorbate 21, polysorbate 40,polysorbate 60, polysorbate 61, polysorbate 65, polysorbate 80,polysorbate 81, polysorbate 85, and polysorbate 120. Polysorbatescontaining approximately 20 moles of ethylene oxide are hydrophilicnonionic surfactants. Examples of polysorbates containing approximately20 moles of ethylene oxide include polysorbate 20, polysorbate 40,polysorbate 60, polysorbate 65, polysorbate 80, polysorbate 85, andpolysorbate 120. Polysorbates are available commercially from Crodaunder the tradename TWEEN™. The number designation of the polysorbatecorresponds to the number designation of the TWEEN, e.g., polysorbate 20is TWEEN 20, polysorbate 40 is TWEEN 40, polysorbate 60 is TWEEN 60,polysorbate 80 is TWEEN 80, etc. USP/NF grades of polysorbate includepolysorbate 20 NF, polysorbate 40 NF, polysorbate 60 NF, and polysorbate80 NF. Polysorbates are also available in PhEur grades (EuropeanPharmacopoeia), BP grades, and JP grades. The term “polysorbate” is anon-proprietary name. The chemical name of polysorbate 20 ispolyoxyethylene 20 sorbitan monolaurate. The chemical name ofpolysorbate 40 is polyoxyethylene 20 sorbitan monopalmitate. Thechemical name of polysorbate 60 is polyoxyethylene 20 sorbitanmonostearate. The chemical name of polysorbate 80 is polyoxyethylene 20sorbitan monooleate. In some embodiments, the composition, carrier,and/or diluent can comprise mixtures of polysorbates. In someembodiments, the composition, carrier, and/or diluent comprisespolysorbate 20, polysorbate 40, polysorbate 60, polysorbate 65,polysorbate 80, polysorbate 85, and/or polysorbate 120. In someembodiments, the composition, carrier, and/or diluent comprisespolysorbate 20, polysorbate 40, polysorbate 60, and/or polysorbate 80.In one embodiment, the composition, carrier, and/or diluent comprisespolysorbate 80.

In some embodiments, the composition comprises antineoplastic particles,a carrier, and optionally a diluent, wherein the carrier and/or diluentcomprises water and a polysorbate. In one embodiment, the composition isa suspension, the antineoplastic particles are taxane particles, and thepolysorbate is polysorbate 80. In other embodiments, the polysorbate orpolysorbate 80 is present in the composition, carrier, and/or diluent ata concentration of between about 0.01% v/v and about 1.5% v/v. Theinventors have surprisingly discovered that the recited very smallamounts of polysorbate 80 reduce the surface tension at the interface ofthe antineoplastic particles and the aqueous carrier (such as salinesolution). These embodiments are typically formulated near the time ofuse of the composition. In some embodiments, the particles may be coatedwith the polysorbate or polysorbate 80. In other embodiments, theparticles are not coated with the polysorbate or polysorbate 80. Invarious other embodiments, the polysorbate or polysorbate 80 is presentin the composition, carrier, and/or diluent at a concentration ofbetween: about 0.01% v/v and about 1% v/v, about 0.01% v/v and about0.5% v/v, about 0.01% v/v and about 0.4% v/v, about 0.01% v/v and about0.35% v/v, about 0.01% v/v and about 0.3% v/v, about 0.01% v/v and about0.25% v/v, about 0.01% v/v and about 0.2% v/v, about 0.01% v/v and about0.15% v/v, about 0.01% v/v and about 0.1% v/v, about 0.05% v/v and about1% v/v, about 0.05% v/v and about 0.5% v/v, about 0.05% v/v and about0.4% v/v, about 0.05% v/v and about 0.35% v/v, about 0.05% v/v and about0.3% v/v, about 0.05% v/v and about 0.25% v/v, about 0.05% v/v and about0.2% v/v, about 0.05% v/v and about 0.15% v/v, about 0.05% v/v and about0.1% v/v, about 0.1% v/v and about 1% v/v, about 0.1% v/v and about 0.5%v/v, about 0.1% v/v and about 0.4% v/v, about 0.1% v/v and about 0.35%v/v, about 0.1% v/v and about 0.3% v/v, about 0.1% v/v and about 0.25%v/v, about 0.1% v/v and about 0.2% v/v, about 0.1% v/v and about 0.15%v/v, about 0.2% v/v and about 1% v/v, about 0.2% v/v and about 0.5% v/v,about 0.2% v/v and about 0.4% v/v, about 0.2% v/v and about 0.35% v/v,about 0.2% v/v and about 0.3% v/v, about 0.2% v/v and about 0.25% v/v,about 0.3% v/v and about 1% v/v, about 0.3% v/v and about 0.5% v/v,about 0.3% v/v and about 0.4% v/v, or about 0.3% v/v and about 0.35%v/v; or about 0.01%, about 0.05%, about 0.1% v/v, about 0.15% v/v, about0.16% v/v, about 0.2% v/v, about 0.25% v/v, about 0.3% v/v, about 0.35%v/v, about 0.4% v/v, about 0.45% v/v, about 0.5% v/v, or about 1% v/v.

The composition, carrier, and/or diluent can comprise one or moretonicity adjusting agents. Suitable tonicity adjusting agents include byway of example and without limitation, one or more inorganic salts,electrolytes, sodium chloride, potassium chloride, sodium phosphate,potassium phosphate, sodium, potassium sulfates, sodium and potassiumbicarbonates and alkaline earth metal salts, such as alkaline earthmetal inorganic salts, e.g., calcium salts, and magnesium salts,mannitol, dextrose, glycerin, propylene glycol, and mixtures thereof.

The composition, carrier, and/or diluent can comprise one or morebuffering agents. Suitable buffering agents include by way of exampleand without limitation, dibasic sodium phosphate, monobasic sodiumphosphate, citric acid, sodium citrate, tris(hydroxymethyl)aminomethane,bis(2-hydroxyethyl)iminotris-(hydroxymethyl)methane, and sodium hydrogencarbonate and others known to those of ordinary skill in the art.Buffers are commonly used to adjust the pH to a desirable range forintraperitoneal use. Usually a pH of around 5 to 9, 5 to 8, 6 to 7.4,6.5 to 7.5, or 6.9 to 7.4 is desired.

The composition, carrier, and/or diluent can comprise one or moredemulcents. A demulcent is an agent that forms a soothing film over amucous membrane, such as the membranes lining the peritoneum and organstherein. A demulcent may relieve minor pain and inflammation and issometimes referred to as a mucoprotective agent. Suitable demulcentsinclude cellulose derivatives ranging from about 0.2 to about 2.5% suchas carboxymethylcellulose sodium, hydroxyethyl cellulose, hydroxypropylmethylcellulose, and methylcellulose; gelatin at about 0.01%; polyols inabout 0.05 to about 1%, also including about 0.05 to about 1%, such asglycerin, polyethylene glycol 300, polyethylene glycol 400, andpropylene glycol; polyvinyl alcohol from about 0.1 to about 4%; povidonefrom about 0.1 to about 2%; and dextran 70 from about 0.1% when usedwith another polymeric demulcent described herein.

The composition, carrier, and/or diluent can comprise one or morealkalinizing agents to adjust the pH. As used herein, the term“alkalizing agent” is intended to mean a compound used to provide analkaline medium. Such compounds include, by way of example and withoutlimitation, ammonia solution, ammonium carbonate, potassium hydroxide,sodium carbonate, sodium bicarbonate, and sodium hydroxide and othersknown to those of ordinary skill in the art.

The composition, carrier, and/or diluent can comprise one or moreacidifying agents to adjust the pH. As used herein, the term “acidifyingagent” is intended to mean a compound used to provide an acidic medium.Such compounds include, by way of example and without limitation, aceticacid, amino acid, citric acid, nitric acid, fumaric acid and other alphahydroxy acids, hydrochloric acid, ascorbic acid, and nitric acid andothers known to those of ordinary skill in the art.

The composition, carrier, and/or diluent can comprise one or moreantifoaming agents. As used herein, the term “antifoaming agent” isintended to mean a compound or compounds that prevents or reduces theamount of foaming that forms on the surface of the fill composition.Suitable antifoaming agents include by way of example and withoutlimitation, dimethicone, SIMETHICONE, octoxynol and others known tothose of ordinary skill in the art.

The composition, carrier, and/or diluent can comprise one or moreviscosity modifiers that increase or decrease the viscosity of thesuspension. Suitable viscosity modifiers include methylcellulose,hydroxypropyl methycellulose, mannitol, polyvinylpyrrolidone,cross-linked acrylic acid polymers such as carbomer, and others known tothose of ordinary skill in the art. The composition, carrier, and/ordiluent can further comprise rheology modifiers to modify the flowcharacteristics of the composition to allow it to adequately flowthrough devices such as injection needles or tubes. Non-limitingexamples of viscosity and rheology modifiers can be found in “RheologyModifiers Handbook—Practical Use and Application” Braun, William AndrewPublishing, 2000.

The concentration or amount of antineoplastic particles in a compositionfor pulmonary administration, intratumoral injection, or intraperitonealinjection is at an “effective amount” to (1) stimulate an immunologicalresponse to the immunotherapeutic agent in the subject, and (2) treatthe tumor(s) of the subject, i.e., to provide a therapeutic effect onthe tumor by accomplishing one or more of the following: (a) reducingtumor size; (b) reducing tumor growth rate; (c) eliminating the tumor.In one embodiment, the concentration of the antineoplastic particles,which can be taxane particles, in the composition is between about 0.1mg/mL and about 100 mg/mL. In various further embodiments, theconcentration of antineoplastic particles, which can be taxaneparticles, in the composition is between: about 0.5 mg/mL and about 100mg/mL, about 1 mg/mL and about 100 mg/mL, about 2 mg/mL and about 100mg/mL, about 5 mg/mL and about 100 mg/mL, about 10 mg/mL and about 100mg/mL, about 25 mg/mL and about 100 mg/mL, about 30 mg/mL and about 100mg/mL, about 0.1 mg/mL and about 75 mg/mL, about 0.5 mg/mL and about 75mg/mL, about 1 mg/mL and about 75 mg/mL, about 2 mg/mL and about 75mg/mL, about 5 mg/mL and about 75 mg/mL, about 10 mg/mL and about 75mg/mL, about 25 mg/mL and about 75 mg/mL, about 30 mg/mL and about 75mg/mL, about 0.1 mg/mL and about 50 mg/mL, about 0.5 mg/mL and about 50mg/mL, about 1 mg/mL and about 50 mg/mL, about 2 mg/mL and about 50mg/mL, about 5 mg/mL and about 50 mg/mL, about 10 mg/mL and about 50mg/mL, about 25 mg/mL and about 50 mg/mL, about 30 mg/mL and about 50mg/mL, about 0.1 mg/mL and about 40 mg/mL, about 0.5 mg/mL and about 40mg/mL, about 1 mg/mL and about 40 mg/mL, about 2 mg/mL and about 40mg/mL, about 5 mg/mL and about 40 mg/mL, about 10 mg/mL and about 40mg/mL, about 25 mg/mL and about 40 mg/mL, about 30 mg/mL and about 40mg/mL, about 0.1 mg/mL and about 30 mg/mL, about 0.5 mg/mL and about 30mg/mL, about 1 mg/mL and about 30 mg/mL, about 2 mg/mL and about 30mg/mL, about 5 mg/mL and about 30 mg/mL, about 10 mg/mL and about 30mg/mL, about 25 mg/mL and about 30 mg/mL, about 0.1 mg/mL and about 25mg/mL, about 0.5 mg/mL and about 25 mg/mL, about 1 mg/mL and about 25mg/mL, about 2 mg/mL and about 25 mg/mL, about 5 mg/mL and about 25mg/mL, about 10 mg/mL and about 25 mg/mL, about 0.1 mg/mL and about 20mg/mL, about 0.5 mg/mL and about 20 mg/mL, about 1 mg/mL and about 20mg/mL, about 2 mg/mL and about 20 mg/mL, about 5 mg/mL and about 20mg/mL, about 10 mg/mL and about 20 mg/mL, about 0.1 mg/mL and about 15mg/mL, about 0.5 mg/mL and about 15 mg/mL, about 1 mg/mL and about 15mg/mL, about 2 mg/mL and about 15 mg/mL, about 5 mg/mL and about 15mg/mL, about 10 mg/mL and about 15 mg/mL, about 0.1 mg/mL and about 10mg/mL, about 0.5 mg/mL and about 10 mg/mL, about 1 mg/mL and about 10mg/mL, about 2 mg/mL and about 10 mg/mL, about 5 mg/mL and about 10mg/mL, about 0.1 mg/mL and about 5 mg/mL, about 0.5 mg/mL and about 5mg/mL, about 1 mg/mL and about 5 mg/mL, about 2 mg/mL and about 5 mg/mL,about 0.1 mg/mL and about 2 mg/mL, about 0.5 mg/mL and about 2 mg/mL,about 1 mg/mL and about 2 mg/mL, about 0.1 mg/mL and about 1 mg/mL,about 0.5 mg/mL and about 1 mg/mL, about 0.1 mg/mL and about 0.5 mg/mL,about 3 mg/mL and about 8 mg/mL, or about 4 mg/mL and about 6 mg/mL; orat least about 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14,15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, 50, 55, 60, 61, 65, 70, 75,or 100 mg/mL; or about 0.1, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 41, 42, 43, 44, 45, 46,47, 48, 49, 50, 55, 60, 61, 65, 70, 75, or 100 mg/mL. The antineoplasticparticles may be the sole therapeutic agent administered, or may beadministered with other therapeutic agents.

In various embodiments, the composition comprises taxane particles(paclitaxel particles or docetaxel particles), a carrier, and a diluent,wherein the concentration of taxane particles in the composition(including the carrier and diluent) is between: about 1 mg/mL and about40 mg/mL, about 5 mg/mL and about 20 mg/mL, about 5 mg/mL and about 15mg/mL, about 5 mg/mL and about 10 mg/mL, about 6 mg/mL and about 20mg/mL, about 6 mg/mL and about 15 mg/mL, about 6 mg/mL and about 10mg/mL, about 10 mg/mL and about 20 mg/mL, or about 10 mg/mL and about 15mg/mL; or about 6 mg/mL, about 10 mg/mL, or about 15 mg/mL. In furtherembodiments, the carrier is an aqueous carrier which can be salinesolution, such as about 0.9% sodium chloride solution and the diluent isan aqueous diluent which can be saline solution, such as about 0.9%sodium chloride solution. In further embodiments, the aqueous carriercomprises a polysorbate, such as polysorbate 80.

In some embodiments, the compositions are free of/do not include orcontain a polymer/copolymer or biocompatible polymer/copolymer. In someembodiments, the compositions are free of/do not include or contain aprotein. In some aspects of the invention, the compositions are freeof/do not include or contain albumin. In some aspects of the invention,the compositions are free of/do not include or contain hyaluronic acid.In some aspects of the invention, the compositions are free of/do notinclude or contain a conjugate of hyaluronic acid and a taxane. In someaspects of the invention, the compositions are free of/do not include orcontain a conjugate of hyaluronic acid and paclitaxel. In some aspectsof the invention, the compositions are free of/do not include or containpoloxamers, polyanions, polycations, modified polyanions, modifiedpolycations, chitosan, chitosan derivatives, metal ions, nanovectors,poly-gamma-glutamic acid (PGA), polyacrylic acid (PAA), alginic acid(ALG), Vitamin E-TPGS, dimethyl isosorbide (DMI), methoxy PEG 350,citric acid, anti-VEGF antibody, ethylcellulose, polystyrene,polyanhydrides, polyhydroxy acids, polyphosphazenes, polyorthoesters,polyesters, polyamides, polysaccharides, polyproteins,styrene-isobutylene-styrene (SIBS), a polyanhydride copolymer,polycaprolactone, polyethylene glycol (PEG), Poly(bis(P-carboxyphenoxy)propane-sebacic acid, poly(d,l-lactic acid) (PLA),poly(d,l-lactic acid-co-glycolic acid) (PLAGA), and/or poly(D, Llactic-co-glycolic acid (PLGA).

In a preferred embodiment, the composition suitable for pulmonaryadministration, intratumoral injection, and/or intraperitoneal injectioncomprises taxane particles and a liquid carrier, wherein the taxaneparticles have a mean particle size (number) of from 0.1 microns to 1.5microns. In further preferred embodiments, the taxane particles arepaclitaxel particles. In further preferred embodiments, the liquidcarrier is an aqueous carrier.

III. Immunotherapeutic Agents and Compositions for Systemic Delivery ofImmunotherapeutic Agents

There are several classes of immunotherapeutic agents used in thetreatment of cancer and include, but are not limited to, the followingclasses:

Monoclonal Antibodies: drugs that are designed to bind to specifictargets in the body. Non-limiting examples of monoclonal antibodiesinclude pertuzumab, trastuzumab, ado-tastruzumab emtansine, bevacizumab,ramucirumab, margetuximab, vantictumab, glembatumumab vedotin,cetuximab, bavituximab, rilotumumab, nivolumab, pembrolizumab, andatezolizumab.Cancer Vaccines: These agents work against cancer by boosting the immunesystem's response to cancer cells. Non-limiting examples of cancervaccines include nelipepimut-S, tergenpumatucel-L, and racotumomab.Non-specific Immunotherapies/Cytokines: proteins that are made by thebody's cells; play important roles in the body's normal immune responsesand also in the immune system's ability to respond to cancer.Non-limiting examples include colony stimulating factors, interferon,and interleukin such as interleukin-2 and interleukin-7.Immune Checkpoint Inhibitors/Immune Modulators: take the ‘brakes’ offthe immune system, which helps it recognize and attack cancer cells.Non-limiting examples include ipilimumab, pembrolizumab, and nivolumab.Adoptive Cell Transfer/T Cell Therapy/Cellular Therapy: attempts toboost the natural ability of your T cells to fight cancer. Non-limitingexamples include tumor infiltrating lymphocytes, T-cells targeting HER2,cMET proteins, CEA, VEGFR-2, MAGE-A3, and lung cancers expressingNY-ESO-1 cancer antigen.Oncolytic Virus Therapy: uses genetically modified viruses to killcancer cells. Non-limiting examples include reovirus.BCG (Bacillus Calmette-Guérin): weakened form of the bacteria thatcauses tuberculosis; causes an immune response against cancer cells.

In some embodiments, the immunotherapeutic agent is a monoclonalantibody, a cancer vaccine, a non-specific immunotherapeutic agent, acytokine, interferon, interleukin, a colony stimulating factor, acheckpoint inhibitor, an immune modulator, an adoptive cell transferagent, a T-cell therapeutic agent, a cellular therapeutic agent, anoncolytic virus therapeutic agent, BCG, and/or an adjuvantimmunotherapeutic agent. In some embodiments, the immunotherapeuticagent is pembrolizumab.

The compositions useful for systemic administration, i.e., the secondcomposition of the invention, are compositions that comprise theimmunotherapeutic agents described herein and throughout thisdisclosure, and are suitable for systemic administration, such asenteral administration or parenteral administration. Non-limitingexamples of routes of systemic administration include intravenous (IV),intramuscular, intraarticular, infusion, oral, rectal, buccal, andsublingual. The compositions can comprise a suitable carrier such as apharmaceutical carrier. In preferred embodiments, the compositions aresterile.

IV. Methods of Administration and Treatment

In one aspect of the invention, disclosed is a method of treating cancerin a subject, the method comprising: (a) administering locally to amalignant tumor of the subject, a first composition comprisingantineoplastic particles, and (b) administering systemically to thesubject, a second composition comprising an immunotherapeutic agent,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns.

A. Local Administration Methods

Local administration of compositions comprising antineoplastic agentparticles directly to a tumor include topical application, pulmonaryadministration, intratumoral injection, and intraperitoneal injection.The compositions for local administration as described herein andthroughout this disclosure are compositions suitable for use in thevarious types of local administration, i.e., topical application,pulmonary administration, intratumoral injection, and intraperitonealinjection.

1. Topical Application Methods

In one aspect of the invention, disclosed is a method of treating cancerin a subject, the method comprising: (a) topically administering a firstcomposition comprising antineoplastic particles to the affected area ofa skin tumor of the subject and (b) systemically administering a secondcomposition comprising an immunotherapeutic agent to the subject,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns, andwherein steps (a) and (b) can be conducted in any order or at the sametime. The skin tumor can be benign, e.g., actinic keratosis; ormalignant (skin malignancy), e.g. skin cancer or cutaneous metastasis.In some embodiments, the tumor in step (a) is a benign tumor, and thesubject has cancer elsewhere in the body. In some embodiments, the tumorin step (a) is a malignant tumor and is the only cancer in the body ofthe subject. In other embodiments, the tumor in step (a) is a malignanttumor and the subject also has cancer elsewhere in the body. The“affected area” of a benign skin tumor or skin malignancy can include atleast a portion of the skin where the benign skin tumor or skinmalignancy is visibly present on the outermost surface of the skin ordirectly underneath the surface of the skin (epithelial/dermalcovering), and can include areas of the skin in the proximity of thebenign skin tumor or skin malignancy likely to contain visiblyundetectable preclinical lesions. The skin malignancy can be a skincancer or a cutaneous metastasis. In some embodiments, the skinmalignancy is a cutaneous metastasis. In other embodiments, the skinmalignancy is a skin cancer. The cutaneous metastasis can be from avariety of primary cancers, such as the following non-limiting examplesof primary cancers: breast, lung, nasal, sinus, larynx, oral cavity,colon (large intestine), rectum, stomach, ovary, testis, bladder,prostate, cervical, vaginal, thyroid, endometrial, kidney, esophagus,pancreas, liver, melanoma, and Kaposi's sarcoma (including AIDS-relatedKaposi's sarcoma). In some embodiments, the cutaneous metastasis is fromlung cancer, breast cancer, colon cancer, oral cancer, ovarian cancer,kidney cancer, esophageal cancer, stomach cancer, or liver cancer. Insome embodiments, the cutaneous metastasis is from breast cancer.Non-limiting examples of skin cancers include melanoma, basal cellcarcinoma, and squamous cell carcinoma. In some embodiments, the methoddoes not include additional skin-directed therapies, such aselectrochemotherapy (ECT), photodynamic therapy (PDT), radiotherapy(RT), or intralesional therapy (ILT).

The amount of the composition topically applied to the affected area ofthe skin malignancy can vary depending on the size of the affected areaand the concentration of the antineoplastic particles in thecomposition, but generally can be applied at approximately the thicknessof a dime to fully cover the affected area. Another suitable method fordetermining the amount of composition to apply is the “Finger-Tip Unit”(FTU) approach. One FTU is the amount of topical composition that issqueezed out from a standard tube along an adult's fingertip (Thisassumes the tube has a standard 5 mm nozzle). A fingertip is from thevery end of the finger to the first crease in the finger. Thecomposition can be applied with a gloved hand or spatula or other meansof topical administration. In some embodiments, the composition isapplied to skin malignancies which have an intact skin covering(epithelial/dermal covering). In some embodiments, the composition isapplied to ulcerated areas where the skin malignancy lesion is on thesurface of the skin or where the skin covering is degraded and the skinmalignancy lesion is exposed. The affected area can be gently cleansedwith water (and mild soap if required) and dried prior to application.Once the composition is applied, the application site can be coveredwith an occlusive dressing such as TEGADERM® or SOLOSITE®. The dosing ofthe composition can vary, but generally can include an application once,twice, or three times daily at approximately the same time each dayuntil the condition is improved or eliminated.

2. Pulmonary Administration Methods

Disclosed herein is a method of treating cancer in a subject, the methodcomprising: (a) administering a first composition comprisingantineoplastic particles to the subject by pulmonary administration, and(b) systemically administering a second composition comprising animmunotherapeutic agent to the subject, thereby treating the cancer,wherein the antineoplastic particles have a mean particle size (number)of from 0.1 microns to 5 microns, wherein the subject has a lungdisease, and wherein steps (a) and (b) can be conducted in any order orat the same time. The lung disease can be non-cancerous or cancerous. Insome embodiments, the lung disease is non-cancerous, and the subject hascancer in areas of the body other than in the lung. The non-cancerouslung disease can be restrictive lung disease such as pulmonary fibrosisor obstructive lung disease such as chronic obstructive lung disease(COPD). In other embodiments, the lung disease is cancerous. In someembodiments, the cancerous lung disease is a malignant tumor ormesothelioma. A malignant lung tumor is any tumor present within thelungs, and may be a primary or a metastatic lung tumor. Non-limitingexamples of a malignant lung tumor include small-cell lung carcinoma(SCLC) and non-small-cell lung carcinoma (NSCLC). In one embodiment, themalignant lung tumor is a SCLC. In another embodiment, the malignantlung tumor is a NSCLC. It has been shown that pulmonary administrationof taxane particles according to the methods of the invention result inmuch longer residency times of the taxane in the lungs than waspreviously possible using any other taxane formulation. As shown in theexamples that follow, the taxane remains detectable in lung tissue ofthe subject for at least 96 hours (4 days) or at least 336 hours (14days) after the administration. In various further embodiments, thetaxane remains detectable in lung tissue of the subject for at least:108, 120, 132, 144, 156, 168, 180, 192, 204, 216, 228, 240, 252, 264,276, 288, 300, 312, 324, or 336 hours after the administration. In someembodiments, the cancerous lung disease is the only cancer in the body.In some embodiments, the subject has cancerous lung disease and cancerin other areas of the body.

In one specific embodiment of the invention, pulmonary administrationcomprises inhalation of the first composition comprising theantineoplastic particles, such as by nasal, oral inhalation, or both. Inthis embodiment, the first composition comprising the antineoplasticparticles may be formulated as an aerosol (i.e.: liquid droplets of astable dispersion or suspension of the antineoplastic particles in agaseous medium). Antineoplastic particles delivered as an aerosolcomposition may be deposited in the airways by gravitationalsedimentation, inertial impaction, and/or diffusion. Any suitable devicefor generating the aerosol may be used, including but not limited topressurized metered-dose inhalers (pMDI), nebulizers, and soft-mistinhalers. In some embodiments, the antineoplastic particles may be indry powder form and used in dry powder inhalers (DPI). The drugparticles are typically placed in a capsule in a DPI device. Uponactuation, the capsule is ruptured and the cloud of dry powder isexpelled. The drug powder can be adjusted to the desired mass medianaerodynamic diameter (MMAD) but the most common practice is to blend thesmall drug powders with a carrier like lactose for pulmonary delivery.The drug particles adhere to the lactose particles by static adhesion.The lactose for pulmonary delivery can be sized to the desired MMAD,such as about 2.5 microns. Other sugars such as mannitol can also beused.

In one specific embodiment, the methods comprise inhalation of the firstcomposition comprising antineoplastic particles aerosolized vianebulization. Nebulizers generally use compressed air or ultrasonicpower to create inhalable aerosol droplets of the composition comprisingthe aerosol particles. In this embodiment, the nebulizing results inpulmonary delivery to the subject of aerosol droplets of the compositioncomprising the antineoplastic particles. In a preferred embodiment, theantineoplastic particles are taxane particles. In a further preferredembodiment, the taxane particles are paclitaxel particles. A suitablenebulizer is a Hospitak compressed air jet nebulizer.

In another embodiment, the methods comprise inhalation of the firstcomposition comprising antineoplastic particles aerosolized via a pMDI,wherein the composition comprising the antineoplastic particles aresuspended in a suitable propellant system (including but not limited tohydrofluoroalkanes (HFAs) containing at least one liquefied gas in apressurized container sealed with a metering valve. Actuation of thevalve results in delivery of a metered dose of an aerosol spray of thecomposition comprising antineoplastic particles. In a preferredembodiment, the antineoplastic particles are taxane particles. In afurther preferred embodiment, the taxane particles are paclitaxelparticles.

In embodiments where the compositions comprising the antineoplasticparticles are aerosolized for administration, the mass medianaerodynamic diameter (MMAD) of the aerosol droplets of the compositionscomprising the antineoplastic particles may be any suitable diameter foruse in the invention. In one embodiment, the aerosol droplets have aMMAD of between about 0.5 μm to about 6 μm diameter. In various furtherembodiments, the aerosol droplets have a MMAD of between about 0.5 μm toabout 5.5 μm diameter, about 0.5 μm to about 5 μm diameter, about 0.5 μmto about 4.5 μm diameter, about 0.5 μm to about 4 μm diameter, about 0.5μm to about 3.5 μm diameter, about 0.5 μm to about 3 μm diameter, about0.5 μm to about 2.5 μm diameter, about 0.5 μm to about 2 μm diameter,about 1 μm to about 5.5 μm diameter, about 1 μm to about 5 μm diameter,about 1 μm to about 4.5 μm diameter, about 1 μm to about 4 μm diameter,about 1 μm to about 3.5 μm diameter, about 1 μm to about 3 μm diameter,about 1 μm to about 2.5 μm diameter, about 1 μm to about 2 μm diameter,about 1.5 μm to about 5.5 μm diameter, about 1.5 μm to about 5 μmdiameter, about 1.5 μm to about 4.5 μm diameter, about 1.5 μm to about 4μm diameter, about 1.5 μm to about 3.5 μm diameter, about 1.5 μm toabout 3 μm diameter, about 1.5 μm to about 2.5 μm diameter, about 1.5 μmto about 2 μm diameter, about 2 μm to about 5.5 μm diameter, about 2 μmto about 5 μm diameter, about 2 μm to about 4.5 μm diameter, about 2 μmto about 4 μm diameter, about 2 μm to about 3.5 μm diameter, about 2 μmto about 3 μm diameter, and about 2 μm to about 2.5 μm diameter. Inpreferred embodiments, the antineoplastic particles are taxane particlesand the aerosol droplets have a mass median aerodynamic diameter (MMAD)of between about 0.5 μm to about 6 μm diameter, or between about 1 μm toabout 3 μm diameter, or about 2 μm to about 3 μm diameter. A suitableinstrument for measuring the mass median aerodynamic diameter (MMAD) andgeometric standard deviation (GSD) of the aerosol droplets is aseven-stage aerosol sampler such as the Mercer-Style Cascade Impactor.

3. Intratumoral (IT) Injection Methods

Disclosed herein is a method of treating cancer in a subject, the methodcomprising: (a) administering a first composition comprisingantineoplastic particles directly into a solid tumor of the subject byintratumoral injection, and (b) systemically administering a secondcomposition comprising an immunotherapeutic agent to the subject,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns, andwherein steps (a) and (b) can be conducted in any order or at the sametime.

As used herein, a “solid tumor” is an abnormal mass of tissue thatusually does not contain cysts or liquid areas. Solid tumors may bebenign (not cancer) or malignant (cancer). Different types of solidtumors are named for the type of cells that form them. Examples of solidmalignant tumors are sarcomas, carcinomas, and lymphomas. In someembodiments, the solid tumor is a benign tumor, and the subject hascancer elsewhere in the body. In one particular embodiment, the solidtumor is a malignant solid tumor. In some embodiments, the malignantsolid tumor is the only cancer in the body of the subject. In otherembodiments, the subject has a malignant solid tumor and cancer in otherareas of the body.

As used herein, “directly injected into the tumor” or “intratumoralinjection (IT)” means that some or all of the composition, such as asuspension, is injected into the tumor mass. As will be understood bythose of skill in the art, such direct injection may include injectionof some portion of the composition, such as a suspension, for example,drug on the periphery of the solid tumor (“peritumorally”), such as ifthe amount of composition or suspension thereof is too large to all bedirectly injected into the solid tumor mass. In one embodiment, thecomposition or suspension thereof is injected in its entirety into thesolid tumor mass. As used herein the tumor includes both the tumor massand tumor metastases, including but not limited to bone and soft tissuemetastases.

Intratumoral injection of compositions of the antineoplastic particlesinto the tumor may be accomplished by any suitable means known by one ofskill in the art. In non-limiting embodiments, the injection may becarried out via magnetic resonance imaging-transrectal ultrasound fusion(MR-TRUS) guidance (such as for injecting prostate tumors), or viaendoscopic ultrasound-guided fine needle injection (EUS-FNI). Suitableintratumoral injection methods and compositions are disclosed ininternational patent application PCT/US17/25718, herein incorporated byreference.

In various embodiments, the solid tumor is selected from sarcomas,carcinomas, and lymphomas, breast tumors, prostate tumors, head and necktumors, glioblastomas, bladder tumors, pancreatic tumors, liver tumors,ovarian tumors, colorectal tumors, pulmonary, cutaneous, lymphoid,and/or gastrointestinal tumors. In a specific embodiment, the solidtumor is a prostate tumor and the chemotherapeutic particles arepaclitaxel or docetaxel particles. In another specific embodiment, thesolid tumor is an ovarian tumor and the chemotherapeutic particles arepaclitaxel or docetaxel particles. In another specific embodiment, thesolid tumor is a breast tumor and the chemotherapeutic particles aredocetaxel particles. In another specific embodiment, the solid tumor isa pancreatic tumor and the chemotherapeutic particles are paclitaxel ordocetaxel particles. In any of these embodiments, the tumor may be, forexample, an adenocarcinoma.

4. Intraperitoneal (IP) Injection Methods

Disclosed herein is a method of treating cancer in a subject, the methodcomprising: (a) administering a first composition comprisingantineoplastic particles to an intraperitoneal organ tumor of thesubject by intraperitoneal injection, and (b) systemically administeringa second composition comprising an immunotherapeutic agent to thesubject, thereby treating the cancer, wherein the antineoplasticparticles have a mean particle size (number) of from 0.1 microns to 5microns, and wherein steps (a) and (b) can be conducted in any order orat the same time. In some embodiments, the tumor is benign and thesubject has cancer elsewhere in the body. In some embodiments, the tumoris malignant. In some embodiments, the malignant tumor is the onlycancer in the subject. In other embodiments, the subject has a malignanttumor and cancer elsewhere in the body.

Intraperitoneal organs include the stomach, ileum, jejunum, transversecolon, appendix, sigmoid colon, spleen, the liver, the tail of thepancreas, the first five centimeters of the duodenum, and the upperthird part of the rectum. In females, because their peritoneal cavity isopen and communicates with their reproductive organs (the oviductsfacilitate this communication), the uterus, ovaries, fallopian tubes,and gonadal blood vessels are all within the intraperitoneum and areincluded as intraperitoneal organs for purposes of this disclosure.

Intraperitoneal injection of the compositions of antineoplasticparticles into the tumor may be accomplished by any suitable means knownby one of skill in the art. Suitable intraperitoneal injection methodsand compositions are disclosed in U.S. Pat. No. 8,221,779, hereinincorporated by reference.

In some embodiments, the malignant tumor is ovarian cancer, uterinecancer, stomach cancer, colon cancer, spleen cancer, liver cancer,rectal cancer, and/or pancreatic cancer. In some embodiments, the tumoris an ovarian cancer tumor. In some embodiments, the benign tumor is anovarian, uterine, stomach, colon, spleen, liver, rectal, and/orpancreatic benign tumor. In some embodiments, the benign tumor is anovarian tumor.

5. Intracystic Injection Methods

Disclosed herein is a method of treating cancer in a subject, the methodcomprising: (a) administering a first composition comprisingantineoplastic particles directly into a cyst of the subject byintracystic injection, and (b) systemically administering a secondcomposition comprising an immunotherapeutic agent to the subject,thereby treating the cancer, wherein the antineoplastic particles have amean particle size (number) of from 0.1 microns to 5 microns, andwherein steps (a) and (b) can be conducted in any order or at the sametime. In various embodiments, the antineoplastic particles have a meanparticle size (number) of from 0.1 microns to 1.5 microns. In someembodiments, the cyst is an epithelial cyst. In some embodiments, thecyst is a benign cyst, and the subject has cancer elsewhere in the body.In some embodiments, the cyst is a malignant cyst. In some embodiments,the malignant cyst is the only cancer in the body of the subject. Inother embodiments, the subject has a malignant cyst and cancer in otherareas of the body. In some embodiments, the cyst is a pancreatic cyst.In other embodiments, the antineoplastic agent is a taxane and theantineoplastic particles are taxane particles. The taxane particles caninclude pharmaceutically acceptable salts of the taxane particles. Insome embodiments, the taxane particles are paclitaxel particles,docetaxel particles, cabazitaxel particles, or combinations thereof. Insome embodiments, the local administration of the first compositionstimulates an immunological response to the immunotherapeutic agent inthe subject after the systemic administration of the second composition.

As used herein, the term “cyst” means an abnormal sac in the body thatmay be filled with a liquid or semisolid substance. An “epithelial”cyst, has an epithelial inner lining. In some embodiments, the cyst isbenign and/or precancerous. In some embodiments, the cyst is cancerous(malignant). Non-limiting examples of epithelial cysts includegastrointestinal cysts such as hepatic cysts, pancreatic cysts, spleniccysts, colon cysts; urologic cysts such as renal cysts, epididymalcysts, prostatic cysts; gynecological cysts such as ovarian cysts andvaginal cysts; head and neck cysts such as thyroid cysts, parathyroidcysts, and other head and neck cysts; as well as other cysts such asBaker's cysts, lung cysts, lymphatic cysts, and pericardial cysts. Insome embodiments, the epithelial cyst is a pancreatic cyst. A pancreaticcyst can be an intraductal papillary mucinous neoplasm (IPMN), amucinous cystic neoplasms (MCN), or a serous cystadenoma. In someembodiments, the pancreatic cyst is an intraductal papillary mucinousneoplasm (IPMN). In other embodiments, the pancreatic cyst is a mucinouscystic neoplasms (MCN). In still other embodiments, the pancreatic cystis a serous cystadenoma.

The injection of the composition into an epithelial cyst (intracysticinjection) can be conducted by use of a procedure known as “endoscopicultrasound-guided fine needle injection” (EUS-FNI), which is a procedurein which endoscopy is combined with ultrasound to aid in the location ofthe cyst and to facilitate the injection of the composition into thecyst. A non-limiting exemplary procedure for injection of thecomposition into a pancreatic cyst is as follows: a linear arrayechoendoscope is inserted via the mouth and advanced to the stomach orduodenum, whichever provides the best access to the cyst. A 22-gaugefine needle aspiration (FNA) needle is luer locked into the accessorychannel of the echoendoscope. The needle tip is maintained in the cystfor the duration of the procedure. Using a syringe, the cyst fluid isaspirated from the cyst (usually up to 80% of the original volume of thecyst, but more than 80% of the cyst fluid can be aspirated). The volumeof cyst fluid withdrawn is determined. The needle is then filled withthe composition, and is injected directly into the cyst. The volume ofthe composition injected into the cyst can be at a volume equal to thevolume of cyst fluid aspirated.

6. Methods of Injection into a Body Cavity

Disclosed herein is a In another aspect of the invention, disclosed is amethod of treating cancer in a subject, the method comprising: (a)administering a first composition comprising antineoplastic particles toa tumor located in a body cavity of the subject by injection into thebody cavity, and (b) systemically administering a second compositioncomprising an immunotherapeutic agent to the subject, thereby treatingthe cancer, wherein the antineoplastic particles have a mean particlesize (number) of from 0.1 microns to 5 microns, and wherein steps (a)and (b) can be conducted in any order or at the same time. In variousembodiments, the antineoplastic particles have a mean particle size(number) of from 0.1 microns to 1.5 microns. In some embodiments, thetumor is a benign tumor, and the subject has cancer elsewhere in thebody. In some embodiments, the tumor is a malignant tumor. In someembodiments, the malignant tumor is the only cancer in the body of thesubject. In other embodiments, the subject has a malignant tumor andcancer in other areas of the body. In other embodiments, theantineoplastic agent is a taxane and the antineoplastic particles aretaxane particles. The taxane particles can include pharmaceuticallyacceptable salts of the taxane particles. In some embodiments, thetaxane particles are paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof. In some embodiments, thelocal administration of the first composition stimulates animmunological response to the immunotherapeutic agent in the subjectafter the systemic administration of the second composition. A bodycavity is any fluid-filled space other than vessels (such as bloodvessels). Human body cavities include the ventral cavity and the dorsalcavity. The ventral cavity includes the thoracic and abdominopelviccavities and their subdivisions. The dorsal cavity includes the cranialand spinal cavities.

B. Systemic Administration Methods

Systemic administration methods of systemic compositions, i.e., thesecond composition of the invention, include suitable methods as knownby one of skill in the art, such as enteral administration methodsand/or parenteral administration methods. Non-limiting examples ofroutes of systemic administration include intravenous (IV),intramuscular, intraarticular, infusion, oral, rectal, buccal, andsublingual.

C. Combination Therapy Methods

Disclosed herein is a method of treating cancer in a subject, the methodcomprising: (a) administering locally to a tumor or cyst of the subject,a first composition comprising antineoplastic particles, and (b)administering systemically to the subject, a second compositioncomprising an immunotherapeutic agent, thereby treating the cancer,wherein the antineoplastic particles have a mean particle size (number)of from 0.1 microns to 5 microns. In preferred embodiments, the localadministration of the first composition stimulates an immunologicalresponse to the immunotherapeutic agent in the subject after thesystemic administration of the second composition. Steps (a) and (b) canbe conducted in any order or at the same time. In some embodiments, thefirst composition is administered at least one day prior to theadministration of the second composition. In some embodiments, the firstcomposition is administered 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 17, 18, 19, 20, or 21 days prior to the administration ofthe second composition. In other embodiments, the second composition isadministered at least one day prior to the administration of the firstcomposition. In some embodiments, the second composition is administered1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20,or 21 days prior to the administration of the first composition. Instill other embodiments, the first composition and the secondcompositions are administered on the same day. In some embodiments, thecancer in the subject and the malignant tumor of the subject are thesame cancer. In some embodiments, the amount of antineoplastic particlesin the first composition and the amount of immunotherapeutic agent inthe second composition are at effective amounts to treat the cancer inthe subject, and optionally to treat the tumor or cyst of the subject.In some embodiments, the tumor or cyst in step (a) is a benign tumor orcyst, and the subject has cancer elsewhere in the body. In someembodiments, the tumor in step (a) is a malignant tumor or cyst and isthe only cancer in the body of the subject. In other embodiments, thetumor or cyst in step (a) is a malignant tumor or cyst and the subjectalso has cancer elsewhere in the body. In preferred embodiments, theantineoplastic particles are taxane particles.

The combination therapy methods are especially useful for treatingsubjects where prior chemotherapeutic treatments did not show a positiveeffect against the cancer. In some embodiments, prior to receiving thecombination therapy treatment of the invention, the subject received atleast one other form of chemotherapy treatment where the cancerprogressed during and/or after the other form of chemotherapy treatment.In some embodiments, the prior chemotherapy treatment is a platinumbased chemotherapy regimen.

V. Kits

In one aspect of the invention, disclosed is a kit comprising: (a) afirst composition comprising antineoplastic particles, wherein theantineoplastic particles have a mean particle size (number) of from 0.1microns to 5 microns (b) a second composition comprising animmunotherapeutic agent, and (c) instructions for (i) administering thefirst composition locally to a malignant tumor of a subject, and (ii)administering the second composition systemically to a subject. Inpreferred embodiments, the antineoplastic particles are taxaneparticles. In some embodiments, the immunotherapeutic agent is amonoclonal antibody, a cancer vaccine, a non-specific immunotherapeuticagent, a cytokine, interferon, interleukin, a colony stimulating factor,a checkpoint inhibitor, an immune modulator, an adoptive cell transferagent, a T-cell therapeutic agent, a cellular therapeutic agent, anoncolytic virus therapeutic agent, BCG, and/or an adjuvantimmunotherapeutic agent. In some embodiments, the taxane particlescomprise at least 95% of the taxane, and wherein the taxane particleshave a mean particle size (number) of from 0.1 microns to 1.5 microns.In some embodiments, the taxane particles are paclitaxel particles,docetaxel particles, or cabazitaxel particles. In some embodiments, thepaclitaxel particles or docetaxel particles have a specific surface area(SSA) of at least 18 m²/g. In some embodiments, the paclitaxel particlesor docetaxel particles have a bulk density (not-tapped) of 0.05 g/cm³ to0.15 g/cm³. In some embodiments, the first composition is a hydrophobicointment. In some embodiments, the first composition is an aqueoussuspension.

EXAMPLES

The present invention will be described in greater detail by way ofspecific examples. The following examples are offered for illustrativepurposes only, and are not intended to limit the invention in anymanner. Those of skill in the art will readily recognize a variety ofnoncritical parameters, which can be changed or modified to yieldessentially the same results.

Example 1—Particle Size, SSA, and Bulk Density Analysis of PaclitaxelParticles

The particle size of the paclitaxel particles lots used in the formulaslisted in Table 1 and Table 9 were analyzed by the following particlesize method using an ACCUSIZER 780:

Instrument parameters: Max. Concentration: 9000 particles/mL, No.containers: 1, Sensor Range: Summation, Lower Detection Limit: 0.5 μm,Flow Rate: 30 mL/min, No. Analysis pulls: 4, Time between pulls: 1 sec,Pull volume: 10 mL, Tare Volume: 1 mL, Prime volume: 1 mL, Include FirstPull: Not Selected.

Sample preparation: Placed a scoop of paclitaxel particle API into aclean 20 mL vial and added approximately 3 mL of a filtered (0.22 μm)0.1% w/w solution of SDS to wet the API, then filled the remainder ofthe vial with the SDS solution. Vortexed for 5-10 minutes and sonicatedin a water batch for 1 minute.

Method: Filled a plastic bottle with filtered (0.22 μm) 0.1% w/w SDSsolution and analyzed the Background. Pipetted a small amount of thepaclitaxel particles sample suspension, <100 μL, into the bottle of 0.1%w/w SDS solution while stirring; placed the ACCUSIZER inlet tube intothe bottle and ran sample through instrument. As necessary, added moreSDS solution or paclitaxel sample suspension to reach a desired runconcentration of 6000-8000 particle count.

Particles size results (based on number-weighted differentialdistribution): Paclitaxel particles lot used in formulas listed in Table1: Mean: 0.861 μm. Paclitaxel particles lot used in formulas listed inTable 9: Mean: 0.83 μm.

The specific surface area (SSA) of the paclitaxel particles lots used inthe formulas listed in Table 1 and Table 9 were analyzed by theBrunauer-Emmett-Teller (“BET”) isotherm method described above. Thepaclitaxel particles lot used in the formulas listed in Table 1 had anSSA of 41.24 m²/g. The paclitaxel particles lot used in the formulaslisted in Table 9 had an SSA of 26.72 m²/g.

The bulk density (not-tapped) of the paclitaxel particles lot used inthe formulas listed in Table 1 was 0.05 g/cm³. The bulk density(not-tapped) of the paclitaxel particles lot used in the formulas listedin Table 9 was 0.09 g/cm³.

Example 2—Anhydrous Hydrophobic Topical Compositions of PaclitaxelParticles with Hydrophobic Carriers

Anhydrous hydrophobic topical compositions of paclitaxel particles withhydrophobic carriers are listed in Table 1.

TABLE 1 Component Formula Number (% w/w) F4 F5 F6 F7 F8 F9 F10 F11 F12F13 A B C Paclitaxel 1.0 1.0 1.0 1.0 0.5 2.0 1.0 1.0 1.0 1.0 0.5 0.5 0.5Particles FOMBLIN — — — 15.0 — — — — — — — — — HC04 Mineral Oil USP 10.0— 5.0 — 5.0 5.0 — — — — — — — ST- — 5.0 13.0 — 13.0 13.0 13.0 13.0 18.015.0 qs ad qs ad qs ad Cyclomethicone 100 100 100 5 NF(Dow Corning)Oleyl Alcohol — 5.0 — — — — — 1.0 — — — — 5.0 Isopropyl — 5.0 — — — —5.0 1.0 — 3.0 — 35 5.0 Myristate NF Dimethicone — — — — — — — — — — 5.05.0 5.0 Fumed Silica — — — — — — — — — — 5.5 5.5 2.8 Cetostearyl — — — —— — — — 0.5 — — — — Alcohol NF Paraffin Wax NF 5.0 5.0 5.0 5.0 5.0 5.05.0 5.0 5.0 5.0 — — — White qs ad qs ad qs ad qs ad qs ad qs ad qs ad qsad qs ad qs ad — — — Petrolatum 100 100 100 100 100 100 100 100 100 100USP (Spectrum)

Procedure for F4-F13: Prepared a slurry of the paclitaxel particles witha portion of the cyclomethicone (or mineral oil (F4) or FOMBLIN (F7)).Heated the petrolatum to 52±3° C. and added the remaining ingredientsand mixed until melted and homogeneous. Added the paclitaxel slurry andmixed until homogenous. Mixed and allowed the batch to cool to 35° C. orbelow. An ointment was formed.

Example 3—Physical and Chemical Stability of Anhydrous TopicalCompositions of Paclitaxel Particles with Hydrophobic Carriers

The anhydrous hydrophobic topical composition samples were stored at 25°C. and 30° C. in 20 mL, glass scintillation vials. The assay ofpaclitaxel was conducted using HPLC. The results of the assay andappearance stability studies are shown in Table 2 and Table 3 below. Theviscosity was measured at room temperature with a Brookfield RVviscometer using a small sample adapter with a SC4-14 spindle and a 6Rchamber at 5 rpm with an equilibration time of 2 minutes. The viscosityresults are shown in Table 4 below.

TABLE 2 Stability at 25° C. Assay (% of target) Appearance Formula T = 01 month 2 month 3 month T = 0 1 month 2 month 3 month F4 95.3 99.6 100.399.5 Off-white Off-white Off-white Off-white ointment to yellow toyellow to yellow ointment ointment ointment F5 98.2 101.7 101.0 100.9Off-white Off-white Off-white Off-white ointment to yellow to yellow toyellow ointment ointment ointment F6 97.2 100.5 97.9 98.4 Off-whiteOff-white Off-white Off-white ointment to yellow to yellow to yellowointment ointment ointment F6** 98.0 98.5 100.2 NP Off-white Off-whiteOff-white NP to yellow to yellow to yellow ointment ointment ointment F8107.6 100.5 101.1 NP Off-white Off-white Off-white NP to yellow toyellow to yellow ointment ointment ointment F9 95.6 98.3 101.2 NPOff-white Off-white Off-white NP to yellow to yellow to yellow ointmentointment ointment F10 98.6 103.8 101.2 NP Off-white Off-white Off-whiteNP to yellow to yellow to yellow ointment ointment ointment F11 99.899.8 100.9 NP Off-white Off-white Off-white NP to yellow to yellow toyellow ointment ointment ointment F12 98.7 98.3 99.1 NP Off-whiteOff-white Off-white NP to yellow to yellow to yellow ointment ointmentointment F13 96.5 93.9 96.0 NP Off-white Off-white Off-white NP toyellow to yellow to yellow ointment ointment ointment **repeat batch

TABLE 3 Stability at 30° C. Assay (% of target) Appearance Formula T = 01 month 2 month 3 month T = 0 1 month 2 month 3 month F4 95.3 99.5 100.199.7 Off-white Off-white Off-white Off-white ointment to yellow toyellow to yellow ointment ointment ointment F5 98.2 103.2 101.3 99.2Off-white Off-white Off-white Off-white ointment to yellow to yellow toyellow ointment ointment ointment F6 97.2 102.1 98.0 95.0 Off-whiteOff-white Off-white Off-white ointment to yellow to yellow to yellowointment ointment ointment F6** 98.0 98.7 102.0 NP Off-white Off-whiteOff-white NP to yellow to yellow to yellow ointment ointment ointment F8107.6 99.9 103.0 NP Off-white Off-white Off-white NP to yellow to yellowto yellow ointment ointment ointment F9 95.6 101.4 101.9 NP Off-whiteOff-white Off-white NP to yellow to yellow to yellow ointment ointmentointment F10 98.6 100.9 102.9 NP Off-white Off-white Off-white NP toyellow to yellow to yellow ointment ointment ointment F11 99.8 99.8 99.1NP Off-white Off-white Off-white NP to yellow to yellow to yellowointment ointment ointment F12 98.7 99.8 99.5 NP Off-white Off-whiteOff-white NP to yellow to yellow to yellow ointment ointment ointmentF13 96.5 95.6 96.5 NP Off-white Off-white Off-white NP to yellow toyellow to yellow ointment ointment ointment **repeat batch

TABLE 4 Viscosity Stability Viscosity (cps) F4 F5 F6 F7 T = 0 87,50044,300 49,500 81,800 1 month @ 90,300 68,800 57,000 NP 25° C. 3 month @101,000 47,800 38,000 NP 25° C. 1 month @ 123,300 49,300 50,800 NP 30°C. 2 month @ 112,300 53,500 38,000 NP 30° C. 3 month @ 121,300 60,50054,000 NP 30° C.

Example 4—Particle Size Analysis of Paclitaxel Particles in AnhydrousTopical Compositions with Hydrophobic Carriers

Particle Size Method Using an ACCUSIZER Model 770/770A.

Instrument parameters: Sensor: LE 0.5 μm-400 μm, Sensor Range:Summation, Lower Detection Limit: 0.5 μm, Collection time: 60 sec,Number Channels: 128, Vessel Fluid Vol: 100 mL, Flow Rate: 60 mL/min,Max Coincidence: 8000 particles/mL, Sample Vessel: Accusizer Vessel,Sample Calculation: None, Voltage Detector: greater than 10 V, ParticleConcentration Calculation: No, Concentration Range: 5000 to 8000particles/mL, Automatic Data Saving: Selected, Subtract Background: Yes,Number of Autocycles: 1.

Sample Preparation: Added an aliquot of the sample formulation into ascintillation vial. Using a spatula, smeared the sample along the innerwalls of the vial. Added about 20 mL of 2% Lecithin in ISOPAR-G™ (C10-11isoparaffin) solution to the vial. Sonicated the vial for 1 minute.Insured that the sample had adequately dispersed in the solution.

Method: Filled the sample vessel with a filtered (0.22 μm) 2% Lecithinin ISOPAR-G solution and analyzed the background. Using a pipette,transferred a portion of the prepared sample to the vessel whilestirring. Diluted or added sample to the vessel as necessary to providea coincidence level between 5000 to 8000 particles/mL. Initiated theanalysis through the instrument and verified that the coincidence levelwas 5000 to 8000 particles/mL for the analysis.

The results of the particle size analysis are shown in Table 5 and Table6 below.

TABLE 5 Particle size stability at 25° C. Mean particle size, μm(number) 1 3 6 12 Formula Initial month month month month F4 0.77 0.71NP NP NP F5 0.72 0.71 NP NP NP F6 0.72 0.71 NP 0.71 0.72 F6** 0.70 NP0.70 NP NP F8 0.71 NP 0.71 NP NP F9 0.70 NP 0.70 NP NP F10 0.69 NP 0.69NP NP F11 0.69 NP 0.69 NP NP F12 0.70 NP 0.70 NP NP F13 0.69 NP 0.70 NPNP A 0.72 NP NP NP NP B 0.77 NP NP NP NP C 0.84 NP NP NP NP **repeatbatch

TABLE 6 Particle size stability at 30° C. Mean particle size, μm(number) 1 3 6 12 Formula Initial month month month month F4 0.77 0.73NP NP NP F5 0.72 0.70 NP NP NP F6 0.72 0.70 NP 0.70 0.73 F6** 0.70 NP0.72 NP NP F8 0.71 NP 0.71 NP NP F9 0.70 NP 0.71 NP NP F10 0.69 NP 0.69NP NP F11 0.69 NP 0.70 NP NP F12 0.70 NP 0.71 NP NP F13 0.69 NP 0.71 NPNP **repeat batch

Example 5—Aqueous Based Topical Compositions of Paclitaxel Particles

Aqueous based topical compositions of paclitaxel particles are shown inTable 7.

TABLE 7 Component Formula Number (% w/w) F1 F2 F3 D E F G H PaclitaxelParticles 1.0 1.0 1.0 0.5 0.5 0.5 0.5 0.5 DGME 5.0 5.0 — 5.0 5.0 5.0 5.05.0 (TRANSCUTOL P) PEG 400 5.0 5.0 5.0 5.0 5.0 5.0 5.0 5.0 Glycerin 10.010.0 10.0 5.0 5.0 5.0 5.0 5.0 Polysorbate 80 1.0 1.0 1.0 0.1 0.1 0.1 0.10.1 Poloxamer 407 2.0 2.0 2.0 — — — — — Povidone K90 0.15 0.15 0.15 0.10.1 0.1 0.1 0.1 Benzyl Alcohol 0.5 0.5 0.5 — — — — — Methylparaben 0.150.15 0.15 0.15 0.15 0.15 0.15 0.15 Propylparaben 0.02 0.02 0.02 0.020.02 0.02 0.02 0.02 Benzalkonium — 1.0 1.0 — — 0.1 0.1 — Chloride (50%)CARBOPOL 974 P — — — 0.75 — — — — CARBOPOL 0.5 — — — 0.5 — — — ULTREZ 10Trolamine Solution qs pH — — qs pH qs pH — — — (10%) 5.5 5.5 5.5Hydroxypropyl — 1.0 1.0 — — 2.0 — — Methylcellulose (K200M Pharm)Purified Water qs ad qs ad qs ad qs ad qs ad qs ad qs ad qs ad 100 100100 100 100 100 100 100

Example 6—Particle Size Analysis of Paclitaxel Particles in AqueousBased Topical Compositions

Particle Size Method Using an ACCUSIZER Model 770/770A.

Instrument parameters: Sensor: LE 0.5 μm-400 μm, Sensor Range:Summation, Lower Detection Limit: 0.5 μm, Collection time: 60 sec,Number Channels: 128, Vessel Fluid Vol: 100 mL, Flow Rate: 60 mL/min,Max Coincidence: 8000 particles/mL, Sample Vessel: Accusizer Vessel,Sample Calculation: None, Voltage Detector: greater than 10 V, ParticleConcentration Calculation: No, Concentration Range: 5000 to 8000particles/mL, Automatic Data Saving: Selected, Subtract Background: Yes,Number of Autocycles: 1.

Sample Preparation: Added an aliquot of the sample formulation into ascintillation vial. Using a spatula, smeared the sample along the innerwalls of the vial. Added about 20 mL of 0.2 μm filtered distilled waterto the vial. Sonicated the vial for 1 minute. Insured that the samplehad adequately dispersed in the solution.

Method: Filled the sample vessel with 0.2 μm filtered distilled waterand analyzed the background. Using a pipette, transferred a portion ofthe prepared sample to the vessel while stirring. Diluted or addedsample to the vessel as necessary to provide a coincidence level between5000 to 8000 particles/mL. Initiated the analysis through the instrumentand verified that the coincidence level was 5000 to 8000 particles/mLfor the analysis.

The results of the particle size analysis are shown in Table 8 below.

TABLE 8 Particle size of aqueous based topical compositions Meanparticle size, μm (number) 6 month Formula Initial at RT F1 1.06 0.82 F20.74 0.77 F3 0.70 0.77 D 0.80 NP E 0.79 NP F 0.85 NP

Example 7—Topical Compositions of Paclitaxel Particles for Use inTopical Application to Skin Malignancies

The following ointment formulations shown in Table 9 were prepared foruse in topical application to skin malignancies.

TABLE 9 Formula No. F14 F15 F16 F17 Component (% w/w) (0.15%) (0.3%)(1%) (2%) Paclitaxel Particles 0.15 0.3 1.0 2.0 Mineral Oil USP 5.0 5.05.0 5.0 ST-Cyclomethicone 13.0 13.0 13.0 13.0 5 NF (Dow Corning)Paraffin Wax NF 5.0 5.0 5.0 5.0 White Petrolatum qs ad 100 qs ad 100 qsad 100 qs ad 100 USP (Spectrum)

The formulas listed in Table 9 containing paclitaxel particles weremanufactured each in a 6 kg batch size. The formulas were then packagedin 15 gm laminate tubes.

The manufacturing processes for lots F14, F15, and F16 were as follows:The petrolatum, mineral oil, paraffin wax, and a portion of thecyclomethicone were added to a vessel and heated to 52±3° C. whilemixing with a propeller mixer until melted and homogeneous. Thepaclitaxel particles were added to a vessel containing another portionof cyclomethicone and first mixed with a spatula to wet the particles,then mixed with an IKA Ultra Turrax Homogenizer with a S25-25Gdispersing tool until a homogeneous slurry is obtained while keeping thecontainer in an ice/water bath. The slurry was then added to thepetrolatum/paraffin wax container while mixing with the propeller mixerfollowed by rinsing with the remaining portion of cyclomethicone andmixed until the batch was visually homogeneous while at 52±3° C. Thebatch was then homogenized using a Silverson homogenizer. Afterward, thebatch was mixed with a propeller mixer until a homogeneous ointment wasformed and the batch cooled to 35° C. or below.

The manufacturing process for lot F17 was as follows: The petrolatum andparaffin wax were added to a vessel and heated to 52±3° C. while mixingwith a propeller mixer until melted and homogeneous. The paclitaxelparticles were added to a vessel containing the cyclomethicone and aportion of mineral oil, and first mixed with a spatula to wet theparticles, then mixed with an IKA Ultra Turrax Homogenizer with aS25-25G dispersing tool until a homogeneous slurry is obtained whilekeeping the container in an ice/water batch. The slurry was then addedto the petrolatum/paraffin wax container while mixing with the propellermixer followed by rinsing with the remaining portion of mineral oil andmixed until the batch was visually homogeneous while at 52±3° C. Thebatch was then homogenized using a Silverson homogenizer. Afterward, thebatch was mixed with a propeller mixer until a homogeneous ointment wasformed and the batch cooled to 35° C. or below.

The chemical and physical analytical results for each formula in Table 9are shown in Tables 10-13 for T=0, 1 month, and 3 months at 25° C.

TABLE 10 Formula No. F14 (0.15%) Test T = 0 1 month 3 month Appearanceconforms conforms conforms (note1) Assay, % target 103.4 103.2 101.1Viscosity 131000 cps 147000 cps 159500 cps (note 2) Mean Particle 0.71μm 0.70 μm 0.70 μm Size (number) Note 1: Off-white to yellow ointmentNote 2: Brookfield RV viscometer on a helipath stand with the helipathon, with a T-E spindle at 10 RPM at room temperature for 45 seconds.

TABLE 11 Formula No. F15 (0.3%) Test T = 0 1 month 3 month Appearanceconforms conforms conforms (note1) Assay, % target 101.2 101.9 102.5Viscosity 195500 cps 154000 cps 153500 cps (note 2) Mean Particle 0.72μm 0.71 μm 0.70 μm Size (number) Note 1: Off-white to yellow ointmentNote 2: Brookfield RV viscometer on a helipath stand with the helipathon, with a T-E spindle at 10 RPM at room temperature for 45 seconds.

TABLE 12 Formula No. F16 (1%) Test T = 0 1 month 3 month Appearanceconforms conforms conforms (note1) Assay, % target 102.1 102.2 102.7Viscosity 205000 cps 218000 cps 180000 cps (note 2) Mean Particle 0.70μm 0.70 μm 0.70 μm Size (number) Note 1: Off-white to yellow ointmentNote 2: Brookfield RV viscometer on a helipath stand with the helipathon, with a T-E spindle at 10 RPM at room temperahire for 45 seconds.

TABLE 13 Formula No. F17 (2%) Test T = 0 1 month 3 month Appearanceconforms conforms conforms (note1) Assay, % target 101.7 101.1 105.0Viscosity 158000 cps 177000 cps 162000 cps (note 2) Mean Particle 0.70μm 0.69 μm 0.69 μm Size (number) (Note1): Off-white to yellow ointment(Note 2): Brookfield RV viscometer on a helipath stand with the helipathon, with a T-E spindle at 10 RPM at room temperature for 45 seconds.

Example 8—In Vitro Skin Penetration Diffusion Study

A study to determine the rate and extent of in vitro skin permeation ofthe formulas F1 through F13 into and through intact human cadaver skinusing a Franz diffusion cell system was conducted. Concentrations ofpaclitaxel were measured in the receptor chamber of the diffusion cellat varying time points. Upon conclusion of the diffusion study, the skinwas tape stripped and split into epidermal and dermal layers. Thepaclitaxel in the epidermal and dermal tissue was extracted using anextraction solvent and also analyzed.

Analytical Method: A Mass spectrometry (MS) method was developed foranalyzing the paclitaxel. The MS conditions were as follows in Table 14below.

TABLE 14 Instrument: Agilent 1956B MS (TM-EQ-011) Column: XBridge C184.6 × 100 mm, 5 μm Mobile Phase: A: Acetonitrile B: 0.1% Formic acid inwater Time Gradient: (minutes) % B 0 50%  2 5% 5 5% Flow Rate: 1 mL/minColumn Temperature: 30° C. MS Detection: SIM 854.4 + Frag 180, Gain 20Injection Volume: 20 μL Retention time: ~2.86 min

Franz Diffusion Cell (FDC) Study—Methodology

Skin Preparation: Intact human cadaver skin was purchased from New YorkFirefighters Tissue Bank (NFFTB). The skin was collected from the upperback and dermatomed by the tissue bank to a thickness of ˜500 μm. Uponreceipt of the skin from the tissue bank, the skin was stored frozen at−20° C. until the morning of the experiment. Prior to use, the skin wasremoved from the freezer and allowed to fully thaw at room temperature.The skin was then briefly soaked in a PBS bath to remove any residualcryoprotectants and preservatives. Only areas of the skin that werevisually intact were used during the experiment. For each study, twoseparate donors were used, each donor having a corresponding threereplicates.

Receptor Fluid Preparation: Based on the results of preliminarysolubility data, a receptor fluid of 96 wt % phosphate buffered saline(“PBS”) at pH 7.4 and 4 wt % hydroxyl propyl beta cyclodextrin (HPBCD)was chosen. The solubility of the active in the receptor fluid (˜0.4μg/mL) was shown to be adequate to maintain sink conditions during thestudies. The receptor fluid was degassed by filtering the receptor fluidthrough a ZapCap™ CR 0.2 μm membrane while pulling vacuum. The filteredreceptor fluid was stirred for an additional 20 minutes whilemaintaining vacuum to ensure complete degassing.

Diffusion Cell Assembly: The cadaver skin was removed from the freezerand allowed to defrost in a bio-safety hood for 30 minutes. The skin wasthoroughly defrosted prior to opening the package. The cadaver skin wasremoved from the package and placed on the bio-safety hood countertopwith the stratum corneum side up. The skin was patted dry with a KimWipe, then sprayed with fresh PBS and patted dry again. This process wasrepeated 3 more times to remove any residues present on the skin. Thereceptor wells were then filled with the degassed receptor fluid. ATeflon coated stir bar was added to each receptor well. The defrostedcadaver skin was examined and only areas with even thickness and novisible damage to the surface were used. The skin was cut into ˜2 cm×2cm squares. The skin piece was centered on the donor wells, stratumcorneum (SC) side up. The skin was centered and the edges flattened out.The donor and receptor wells were then aligned and clamped together witha clamp. Additional receptor fluid was added where necessary. Any airbubbles present were removed by tilting the cell, allowing air to escapealong the sample port. Diffusion cells were then placed in to thestirring dry block heaters and allowed to rehydrate for 20 minutes fromthe receptor fluid. The block heaters were maintained at 32° C.throughout the experiment with continuous stirring. The skin was allowedto hydrate for 20 minutes and the barrier integrity of each skin sectionwas tested. Once the membrane integrity check study was complete, theentire receptor chamber volume was replaced with the receptor fluid.

Formulation Application Procedure: The formulations were applied to thestratum corneum of the skin. A one-time dosing regimen was used for thisstudy. The test articles were applied as 10 μl doses to the skin using apositive displacement Nichiryom pipetter. The formulations were thenspread across the surface of the skin using a glass rod. Cells were leftuncapped during the experiment. The theoretical dose of paclitaxel percell is shown in Table 15 below.

TABLE 15 % w/w Nominal Theoretical Formula Paclitaxel formulationPaclitaxel Number in formula dose per cell dose per cell F1 1.0 wt % 10μl 182 μg/cm² F2 1.0 wt % 10 μl 182 μg/cm² F3 1.0 wt % 10 μl 182 μg/cm²F4 1.0 wt % 10 μl 182 μg/cm² F5 1.0 wt % 10 μl 182 μg/cm² F6 1.0 wt % 10μl 182 μg/cm² F7 1.0 wt % 10 μl 182 μg/cm² F6* 1.0 wt % 10 μl 182 μg/cm²F8 0.5 wt % 10 μl 91 μg/cm² F9 2.0 wt % 10 μl 364 μg/cm² F10 1.0 wt % 10μl 182 μg/cm² F11 1.0 wt % 10 μl 182 μg/cm² F12 1.0 wt % 10 μl 182μg/cm² F13 1.0 wt % 10 μl 182 μg/cm² *repeat analysis

Sampling of Receptor Fluid: At 3, 6, 12 and 24 hours, 300 μL samplealiquots were drawn from the receptor wells using a graduated Hamiltontype injector syringe. Fresh receptor medium was added to replace the300 μL sample aliquot.

Tape Stripping and Heat Splitting: At 24 hours, the skin was wiped cleanusing PBS/ethanol soaked KimWipes™. After the residual formulation waswiped off and the skin dried with KimWipes™, the stratum comneum wastape stripped three times—each tape stripping consisting of applyingcellophane tape to the skin with uniform pressure and peeling the tapeoff. The tape strips were collected and frozen for future analysis. Thefirst three tape strips remove the uppermost layer of the stratum comeumand act as an extra skin cleaning step. The active is typically notconsidered fully absorbed in this area. These tape strips are usuallyonly analyzed for a mass balance assay. After the skin was tapestripped, the epidermis of each piece was then separated from theunderlying dermal tissue using tweezers or a spatula. The epidermis anddermal tissue were collected and placed in 4 mL borosilicate glassvials. After all the skin pieces were separated, an aliquot of theextraction solvent was added to the glass vial. This process consistedof adding 2 mL of DMSO to the vial and incubating for 24 hours at 32° C.After the extraction time was over, 300 μL sample aliquots of theextraction fluid were collected and filtered.

Analysis of Samples: Sample aliquots were analyzed for paclitaxel usingthe analytical method as described above.

Results:

The results in Table 16 below show the delivered dose of paclitaxel(μg/cm²) in the receptor fluid at various time points (transdermal flux)and the concentration of paclitaxel (μg/cm²) delivered into theepidermis and dermis (penetration) after 24 hours elapsed time forformulations F1 through F13. FIG. 1 graphically shows the concentrationof paclitaxel (μg/cm²) delivered into the epidermis for formulas F1through F7. FIG. 2 graphically shows the concentration of paclitaxel(μg/cm²) delivered into the epidermis for formulas F6*(repeat analysis)and F8 through F13. FIG. 3 graphically shows the concentration ofpaclitaxel (μg/cm2) delivered into the dermis for formulas F1 throughF7. FIG. 4 graphically shows the concentration of paclitaxel (μg/cm2)delivered into the dermis for formulas F6*(repeat analysis) and F8through F13.

Note: Formulas F1 through F6 were tested in one in vitro study, andformulas F6* and F8 through F13 were tested in a second separate invitro study, with different cadaver skin lots. Analysis of formula F6was repeated in the second study (and notated as F6*) so that it couldbe evaluated and compared with the other formulas in the second study.

TABLE 16 Paclitaxel Delivered Dose (μg/cm²) Receptor Receptor ReceptorReceptor Fluid Fluid Fluid Fluid Formula 3 hrs 6 hrs 12 hrs 24 hrsEpidermis Dermis F1 0.000 0.000 0.000 0.000 0.202 0.030 F2 0.000 0.0000.000 0.000 0.161 0.042 F3 0.000 0.000 0.000 0.000 0.056 0.138 F4 0.0000.000 0.000 0.000 0.690 0.639 F5 0.000 0.000 0.000 0.004 0.780 1.337 F60.000 0.000 0.000 0.000 1.927 2.088 F7 0.000 0.000 0.000 0.000 0.6330.882 F6* 0.000 0.000 0.000 0.000 4.910 1.508 F8 0.000 0.000 0.000 0.0003.155 1.296 F9 0.000 0.000 0.000 0.000 7.010 5.679 F10 0.000 0.000 0.0000.000 5.470 0.494 F11 0.000 0.000 0.000 0.000 3.262 1.098 F12 0.0000.000 0.000 0.000 5.269 1.571 F13 0.000 0.000 0.000 0.000 4.903 0.548*repeat analysis

As can be seen by the results in Table 16, the transdermal flux of thepaclitaxel through the skin (epidermis and dermis) was none or only anegligible amount, i.e., less than 0.01 μg/cm². As can be seen by theresults in Table 16 and FIGS. 1, 2, 3 & 4 , the penetration ofpaclitaxel into the skin (epidermis and dermis) was far greater with theanhydrous hydrophobic formulations (F4 through F13) than with theaqueous formulations (F1 through F3), even though the aqueousformulations contained the skin penetration enhancer DGME (TRANSCUTOLP). The results also show that the anhydrous hydrophobic formulationswith cyclomethicone exhibited greater skin penetration (epidermis anddermis) over the anhydrous hydrophobic formulations withoutcyclomethicone. Additionally, the results show that the addition ofother skin penetration enhancers to the anhydrous hydrophobicformulations containing cyclomethicone had little or no effect on theskin penetration (epidermis and dermis) of these compositions.

Example 9—Phase 1/2 Dose-Rising, Safety, Tolerability and Efficacy Studyfor Cutaneous Metastases

Three of the formulations in Table 9, F14 (0.15%), F16 (1.0%), and F17(2.0%), above were used in an FDA approved Phase 1/2 dose-rising,safety, tolerability and efficacy study for cutaneous metastases inhumans. The study is currently on-going. This was a Phase 1/2,open-label, dose-rising study evaluating the safety tolerability, andpreliminary efficacy of three of the formulations from Table 7: F14(0.15%), F16 (1.0%), and F17 (2.0%) applied topically twice daily for 28days to non-melanoma cutaneous metastases.

A treatment area of 50 cm² on the trunk or extremities containing atleast one eligible lesion was determined at baseline by the RECIST(version 1.1) definition of measurable tumors (greater than or equal to10 mm in its longest diameter). All lesions within the treatment areawere measured by caliper to confirm eligibility. Using a gloved hand,subjects applied one fingertip unit (FTU) of the formulation to the 50cm² treatment area twice daily at approximately the same time each dayfor 28 days. A FTU is defined as the amount of ointment formulationexpressed from a tube with a 5-mm diameter nozzle, applied from thedistal skin-crease to the tip of the index finger of an adult. Subjectsattended the clinic on Day 1 for dose application training andobservation of the first treatment application. Additional visits wereon Days 8, 15, 29, and 43. The final visit was completed 30 days afterthe last study drug dose to review adverse events. Study participationis separated into a dose-escalation phase and a dose expansion phase.

Dose Escalation Phase: During the dose-escalation phase the studyfollowed a standard 3+3 dose-ascending design, with the first cohort ofthree subjects commencing treatment with formulation F14 (0.15%). Asafety monitoring committee reviewed all available data after the lastsubject in each cohort of three subjects completed 15 days of treatmentto determine whether dose escalation may continue.

Dose Expansion Phase: In the dose-expansion phase, additional subjectswere enrolled to reach a maximum of 12 total subjects at the dose leveldetermined in the dose escalation phase. Subjects in the dose expansionphase attended the clinic on the same visit days and received the sameevaluations as the dose escalation phase above.

Objectives: The primary objective of the study was to determine thepreliminary safety and tolerability of the formulations. The secondaryobjectives were to determine the preliminary efficacy of theformulations, to study potential reduction in pain in the treatmentarea, and to describe the pharmacokinetics of the formulations appliedto metastatic lesions.

Population: A minimum of two up to a maximum of 24 male and female humansubjects, greater than or equal to 18 years of age, with non-melanomacutaneous metastases.

Primary Endpoint: Safety and tolerability, as demonstrated by adverseevents, changes in laboratory assessments, physical examinationfindings, and vital signs.

Secondary Endpoints: For the purposes of the following secondaryendpoint for efficacy, eligible lesions were determined at baseline bythe RECIST (Version 1.1) definition of measurable tumors (greater thanor equal to 10 mm in its longest diameter (EISENHAUER et al. Newresponse evaluation criteria in solid tumors: revised RECIST guideline(version 1.1). European Journal of Cancer. 2009; 45; 228-247).

Objective Tumor Response, defined as the difference in the sum ofeligible tumor diameter(s) within the treatment area between baselineand Day 43 (i.e., 14 days after the last dose in the dose escalation andexpansion phases depending on dose regimen). Tumor surface area andresponse were assessed at all visits. Change in surface area wasassessed using a calibrated grid measurement system (ImageJ freeware)provided by the National Institutes of Health (NIH). Lesions weremeasured and analyzed using ImageJ.Objective Clinical Response is defined as subjects with CompleteClinical Response (CR)+Partial Response (PR), further defined as thepercentage of patients who achieve complete clinical response or partialresponse 14 days after the last treatment with the formulation, measuredas change in the sum of the longest diameter(s) of eligible targetlesion(s) within the treatment area 14 days after last treatment. Theresponse to treatment was evaluated as a function of post-treatmenttotal diameter divided by pre-treatment total diameter.Best Overall Response is defined as the best response recorded from thestart of the study treatment until the end of treatment, i.e., Day 43.Complete Clinical Response (CR) is defined as absence of any detectableresidual disease in eligible lesion(s) within the treatment area;Partial Response (PR) is at least a 30% decrease in the sum of thediameters of the eligible lesions(s) within the treatment area comparedto bassline; and Progressive Disease (PD) is at least a 20% increase inthe sum of diameters of eligible lesion(s) within the treatment area,taking as a reference the smallest sum on study. In addition, the summust also demonstrate an absolute increase of at least 5 mm. StableDisease (SD) is defined as the sum of eligible lesion diameter(s)between that defined as PR or PD.The appearance of new non-target lesions during participation in thisstudy does not constitute progressive disease.Pain at the treatment area will be measures by the Numeric Rating Scale(NRS-11). Change in pain will be analyzed from baseline to Day 43.Systemic exposure as determined by: T_(max), C_(max), AUC.

Preliminary Results: Preliminary results for the on-going study includephotos of skin metastatic lesions on the chest of a woman with Stage 4breast cancer. The subject was enrolled in the study after completing IVtherapy with nab-Paclitaxel for breast cancer. One month later, thetreatment began by topical application of formulation F14 (0.15%). FIG.5 is a photo taken at baseline (Day 1) and shows the index lesion(arrow) covered with congealed exudate from an ulcerated lesion. FIG. 6is a photo taken at Day 8 after topical treatment of the formulation F14(0.15%) applied over the same treatment site twice per day. The surfaceof the lesion contains an area of epidermal loss and presumptiveulceration limited to the dermis. FIG. 7 is a photo at Day 15 aftertopical treatment of the formulation F14 (0.15%) applied over the sametreatment site twice per day. A small amount of old exudate can be seenon the medial portion of the lesion as well as no apparent epidermalulceration. FIG. 8 a is a photo at Day 29 after topical treatment of theformulation F14 (0.15%) applied over the same treatment site twice perday. During the 28 days of treatment, the subject's cutaneous lesionswere surrounded by erythema and expanded without ulceration, indicativeof a local immune response (FIG. 8 a ). Eleven days after treatmentended, the subject was again treated with systemic paclitaxel. Threedays after treatment with systemic paclitaxel, two weeks after the studytreatment ended, the subject's lesions significantly decreased in sizeand volume as shown in FIG. 8 b . The local treatment with topicalformulation F14 (0.15%) sensitized the cutaneous lesion to subsequentresponse to IV paclitaxel. The lesion appears to be epithelialized withno evidence of ulceration. In contrast, the natural history of anulcerative cutaneous breast cancer metastasis is rapid expansion andfurther penetration through the dermis once the epidermal surface isbreached by the tumor typically resulting in ulceration.

Example 10—Dermal Toxicity Study

A dermal toxicity study was conducted using the topical compositionsshown in Table 17.

TABLE 17 Formula No. F18 (0.0%) F19 F20 F21 Component (% w/w) Placebo(0.3%) (1%) (3%) Paclitaxel Particles 0.0 0.3 1.0 3.0 Mineral Oil USP5.0 5.0 5.0 5.0 ST-Cyclomethicone 13.0 13.0 13.0 13.0 5 NF (Dow Corning)Paraffin Wax NF 5.0 5.0 5.0 5.0 White Petrolatum qs ad 100 qs ad 100 qsad 100 qs ad 100 USP (Spectrum)

The GLP-compliant study was conducted in Gottingen minipigs tocharacterize the toxicity of the formulations applied topically to 10%body surface area daily for 28 days. The 4 formulations shown in Table17 were applied at the maximal feasible volume of 2 mL/kg, correlatingto dose concentrations of 0.0, 0.3, 1.0, and 3%, which translate to doselevels of 0, 4.9, 16.5, and 49.9 mg/kg/day respectively. Reversibilityof findings was also evaluated following a 2-week recovery period.Parameters evaluated included clinical observations, mortality andmoribundity checks, dermal scoring, body weight, food consumption, eyeexaminations, test site photographs, electrocardiology, clinicalpathology, bioanalysis and toxicokinetic evaluation, organ weights,macroscopic pathology and histopathology. There were noformulation-related effects on survival, clinical signs, dermalirritation, body weights, body weight gains, food consumption,ophthalmic findings, or cardiology parameters. Minimal dermal irritationwas observed in all groups during the dosing phase and was consideredvehicle or procedurally related as the frequency and severity of thefindings were comparable between the placebo controls and activeformulation-treated groups. Thus, the presence of the paclitaxelparticles in the formulations had a negligible effect on dermalirritation.

Example 11—NanoPac® (i.e.: Paclitaxel Particles as Disclosed Herein,Approximately 99% Paclitaxel with a Mean Particle Size (Number) of 0.878Microns in these Examples) Inhalation Safety and Efficacy DevelopmentProgram—Pilot Pharmacokinetic Study in Sprague Dawley Rats Summary

The objective of this pilot study was to define sampling time points fora complete pharmacokinetic (PK) study with NanoPac®. Due to thepotential for the NanoPac® formulation to result in increased retentionin the lungs, nine time points from 0.5 to 168 hours were evaluated todetermine the appropriate sampling strategy for a completepharmacokinetic study.

Sixteen (16) Sprague Dawley rats were exposed to NanoPac® (paclitaxel;target dose of 0.37 mg/kg) by nose only inhalation on a single occasion.Two animals (n=2) were euthanatized at their designated time point of0.5, 6, 12, 24, 48, 72, 120 and 168 hours post exposure. Samples ofblood (plasma) and lung tissue were collected.

On the day of exposure, the NanoPac® suspension formulation (6 mg/mL)was prepared as per instructions provided by the sponsor

Total aerosol exposure time was 63 minutes for all animals. Aerosolconcentration was monitored throughout the 63 minute NanoPac®formulation aerosol exposure by measuring the amount of formulationaccumulated on 47-mm GF/A filters positioned at the breathing zone in anose-only exposure chamber. The aerosol particle size (droplet size) wasmeasured using Mercer style cascade impactor from animal breathing zoneon the exposure chamber.

NanoPac® suspension formulation was aerosolized using two Hospitakcompressed air jet nebulizers (average Paclitaxel aerosol concentration:target 82.65 μg/L). The overall average aerosol concentration asmeasured from the GF/A filters was 0.24 mg/L, and the average Paclitaxelaerosol concentration was 73.5 μg/mL. The particle size distribution wasmeasured to be 2.0 μm MMAD with a GSD of 2.2. The measured averagePaclitaxel aerosol concentration of 73.5 μg/L was ˜110% lower fromtarget average Paclitaxel aerosol concentration of 82.65 μg/L (withinthe accuracy/recovery performance criteria of the analytical assay of+15% as reported in example 3). Oxygen and temperature were monitoredthroughout the NanoPac® formulation aerosols exposure. The recordedoxygen and temperature ranges were 19.7%-20.9% and 20.4° C.-20.8° C.,respectively.

Paclitaxel deposited dose to the lung was calculated based on thePaclitaxel average aerosol concentration of 73.5 μg/L, average rodentbody weight of 326 g, assumed deposition fraction of 10% and exposureduration of 63 minutes. The average achieved rodent deposited dose wasdetermined to be 0.33 mg/kg. The average achieved deposited dose was˜11% lower when compared to target deposited dose of 0.37 mg/kg, but waswithin the expected variability (±15% from target) for nebulizedexposures.

All animals survived to their designated necropsy timepoint. Atnecropsy, several animals had minimal, red discolorations on the lungs.No other abnormal gross observations were noted at necropsy. From bodyand lung weights obtained at necropsy, average terminal bodyweight amonganimals at all timepoints (standard deviation) was 346.26 g (24.01); andaverage lung weight (standard deviation) was 1.60 g (0.13).

Systemic blood (in the form of plasma from K2EDTA) was assayed via theliquid chromatography-mass spectrometry (LCMS) assay and lung tissue wasassayed as briefly described in section (Bioanalytical Analysis) toquantify the amount of paclitaxel as a function of time. The lung tissueanalysis showed lung exposure with detectable amounts of Paclitaxel outto 168 hours. The systemic blood showed no detectable Paclitaxel (under1 ng/mL) after 24 hours. Based on these data the following samplingtimepoints are suggested for the PK study: 0.5 (+10 minutes), 6 (+10minutes), 12 (+10 minutes), 24 (+30 minutes), 48 (+30 minutes), 72 (+30minutes), 120 (+30 minutes) 168 (+30 minutes), 240 (+30 minutes) and 336(+30 minutes) hours post inhalation exposure.

Objectives

The objective of this pilot study was to define sampling timepoints fora complete pharmacokinetic (PK) study with NanoPac®. The preliminarydata with NanoPac® dosed by intraperitoneal (IP) injection indicate asignificant retention time in the intraperitoneal cavity. Due to thepotential for the NanoPac® formulation to result in increased retentionin the lungs, time points out to 168 hours were evaluated to determinethe appropriate sampling strategy for a complete pharmacokinetic study.

Materials and Methods Test System: Species/Strain: Sprague Dawley Rats

Age of Animals at Study Start: 8-10 weeks of age

Body Weight Range at Study Start: 308-353 g

Number on Study/Sex: 18 Males (16 study animals and 2 spares)

Source: Charles River Laboratories (Kingston, N.Y.)

Identification: Permanent maker tail marking

Test and Control Article Formulation and Administration

NanoPac® suspension formulation (6 mg/mL) was prepared as perinstructions provided by the sponsor. Briefly, 5.0 mL of 1% Polysorbate80 was added to the vial containing NanoPac® (306 mg) particles.NanoPac® vial was shaken vigorously and inverted to ensure wetting ofall particles present in the NanoPac® vial. Immediately after shaking,46 mL of 0.9% Sodium Chloride was added to the NanoPac® vial and thevial was shaken for at least 1 minute to make sure sufficient mixing andproper dispersion of suspension. Resultant formulation was leftundisturbed for at least 5 minutes to reduce any air/foam in the vialbefore placing it in the nebulizer for aerosolization work. The finalformulation was kept at room temperature and used within 3 hours afterreconstitution.

Experimental Design

Sixteen (16) Sprague Dawley rats were exposed to NanoPac® (paclitaxel;target dose of 0.37 mg/kg) by nose only inhalation on a single occasion.Two animals (n=2) were euthanatized at 0.5 (+10 minutes), 6 (+10minutes), 12 (+10 minutes), 24 (+30 minutes), 48 (+30 minutes), 72 (+30minutes), 120 (+30 minutes) and 168 (+30 minutes) hours post exposurefor blood (plasma) and lung tissue collections. No specific PK modelingwas done; rather, data will define the duration for detectable amountsof paclitaxel post exposure for the PK Study.

Husbandry, Quarantine and Assignment to Study

Male Sprague Dawley rats (6-8 weeks old) were obtained from CharlesRiver Laboratories (Kingston, N.Y.) and quarantined for 14 days. At theend of quarantine, animals were weighed and then randomized by weightfor assignment to study. Animals were identified by tail marking andcage card. Water, lighting, humidity, and temperature control weremaintained and monitored using standard techniques. Rats were fed astandard rodent diet ad libitum during non-exposure hours.

Body Weights and Daily Observations

Body weights were collected at randomization, daily throughout the studyand at euthanasia. Each animal on study was observed twice daily byComparative Medicine Animal Resources (CMAR) personnel for any clinicalsigns of abnormality, moribundity or death.

Nose-Only Aerosol Exposures Conditioning

Animals were conditioned to nose-only exposure tubes for up to 70minutes using standard techniques. Three conditioning sessions occurredover three days prior to exposure, with the first session lasting 30minutes, the second 60 minutes and the third 70 minutes. They weremonitored closely throughout the conditioning periods and duringexposures to assure that they did not experience more than momentarydistress.

Exposure System

The inhalation exposure system consisted of two compressed air jetnebulizer (Hospitak) and a rodent nose-only inhalation exposure chamber.Exposure oxygen levels (%) were monitored throughout the exposure.NanoPac® suspension aerosol was generated with a set of two compressedair jet nebulizers (used for up to 40 (+1) minutes, then replaced with asecond set of two compressed air jet nebulizers for remaining exposureduration) with an inlet pressure of 20 psi. The aerosol was directedthrough a 24-inch stainless steel aerosol delivery line (with a 1.53 cmdiameter) into a nose-only exposure chamber.

Concentration Monitoring

Aerosol concentration monitoring was conducted by collecting aerosolsonto pre-weighed GF/A 47-mm filters. The filters were sampled fromrodent breathing zones of the nose-only exposure chamber throughout therodent exposure. The aerosol sampling flow rate through GF/A filterswere maintained at 1.0±0.5 L/minute. A total of six GF/A filters werecollected, one every 10 minutes throughout the exposure duration with anexception of the last filter which was collected after 13 minutes. Aftersample collection, filters were weighed to determine the total aerosolconcentration in the exposure system. The filters were extracted andanalyzed by high performance liquid chromatography (HPLC) to quantifythe amount of Paclitaxel collected on each filter. The total aerosolconcentration and Paclitaxel aerosol concentrations were calculated foreach filter by dividing the total amount of aerosols and Paclitaxelaerosols collected with total air flow through the filter. The averagePaclitaxel aerosol concentration was used to calculate the achievedaverage deposited dose of Paclitaxel to the rodent lungs using equation1 as shown below.

Aerosol Particle (Droplet) Size Determination

Particle size distribution of aerosols was measured from rodentbreathing zone of the nose-only exposure chamber by a Mercer-style,seven-stage cascade impactor (Intox Products, Inc., Albuquerque, N.Mex.). The particle size distribution was determined in terms of massmedian aerodynamic diameter (MMAD) and geometric standard deviation(GSD). Cascade impactor sample was collected at a flow rate of 2.0±0.1L/min.

Determination of Dose

Deposited dose was calculated using Equation 1. In this calculation, theaverage aerosol concentration measured from the exposures along withaverage group body weights for rats were used. In this manner theestimated amount of Paclitaxel that was deposited in the rat lungs wascalculated using the measured Paclitaxel aerosol concentration.

$\begin{matrix} & {{Equation}1}\end{matrix}$${{DD}\left( {{\mu g}/{kg}} \right)} = \frac{A{C\left( {{\mu g}/L} \right)} \times {{RMV}\left( {L/{\min.}} \right)} \times {DF} \times {T\left( {\min.} \right)}}{B{W\left( {kg} \right)}}$

where:

-   -   Deposited Dose=(DD) μg/kg    -   ²Respiratory minute volume (RMV)=0.608×BW0.852    -   Aerosol exposure concentration (AC)=Paclitaxel aerosol        concentration (μg/L)    -   Deposition Fraction (DF)=assumed deposition fraction of 10%    -   BW=average body weight (at randomization; Day −1) of animals on        study (kg)

Euthanasia and Necropsy

Animals were euthanized at their respective time points by an IPinjection of euthanasia solution. During necropsy, blood (for plasma)was collected by cardiac puncture into K2EDTA tube, lungs were weighed,lung tissue samples were collected and snap frozen in liquid nitrogenfor bioanalytical analyses. Additionally, a full gross examination wasperformed by qualified necropsy personnel. External surfaces of thebody, orifices, and the contents of the cranial, thoracic, and abdominalcavities were examined. Lesions were described and recorded using a setof glossary terms for morphology, quantity, shape, color, consistency,and severity.

Bioanalytical Analyses

Systemic blood (in the form of plasma from K2EDTA) and lung tissue wereassayed via the liquid chromatography-mass spectrometry (LCMS) assay toquantify the amount of paclitaxel as a function of time. In brief, theassay utilizes an ultra-performance liquid chromatography tandem massspectrometry (UPLC-MS/MS) assay to quantify paclitaxel. Plasma samplesare extracted via a protein precipitation method and separation isachieved via reversed phase chromatography. Lung samples werehomogenized with water at a ratio of 4:1 (water:lung tissue). Thehomogenate then underwent a similar protein precipitation method priorto analysis on the LCMS. Quantification was conducted with a matrixbased calibration curve.

No pharmacokinetic modeling was conducted on these data; however, theconcentration at which paclitaxel drops below the sensitivity limits ofthe assay (1 ng/mL) was used to define the sampling timepoints for themain PK study.

Results Clinical Observations and Survival

All animals survived to their designated necropsy timepoint and gainedweight. No abnormal clinical observations were noted through theduration of the study.

NanoPac® Exposures Aerosol Concentration

Table 18 shows total aerosol and Paclitaxel aerosol concentrationsmeasured by sampling each GF/A filter during exposures. The inhalationexposure average Paclitaxel aerosol concentration of 73.5 μg/L was ˜110%lower from target average Paclitaxel aerosol concentration of 82.65μg/L. The average exposure aerosol concentration was within ±15% oftarget aerosol concentration which was expected for nebulized inhalationexposures.

TABLE 18 Aerosol concentrations during inhalation exposure. PaclitaxelTotal Aerosol Aerosol Filter ID Conc. (mg/L) Conc. (μg/L) FS-1 0.23068.97 FS-2 0.236 71.82 FS-3 0.240 77.58 FS-4 0.268 87.11 FS-5 0.20562.11 FS-6 0.237 73.12 Average 0.24 73.5 SD 0.02 8.4 % RSD 8.55 11.5

Oxygen and Temperature

The recorded oxygen and temperature ranges were 19.7%-20.9% and 20.4°C.-20.8° C., respectively.

Particle Size

The particle size distribution was determined in terms of MMAD (GSD) for6.0 mg/mL NanoPac® formulation aerosols using cascade impactor was 2.0(2.2) μm.

Deposited Dose

Based on Paclitaxel average aerosol concentration of 73.5 μg/L, averagerodent Day −1 (randomization) body weight of 326 g, assumed depositionfraction of 10% and exposure duration of 63 minutes; the averageachieved rodent deposited dose was determined to be 0.33 mg/kg. Theaverage achieved deposited dose was ˜11% lower when compared to targetdeposited dose of 0.37 mg/kg due to expected variability (±15% fromtarget) in exposure average aerosol concentration.

Necropsy

All animals survived to their designated necropsy timepoint. At necropsyseveral animals had minimal, red discolorations on the lungs. No otherabnormal gross observations were noted at necropsy. Individual andaverage lung weights, body weights and ratios were determined. Averageterminal bodyweight (standard deviation) was 346.26 g (24.01). Averagelung weight (standard deviation) was 1.60 g (0.13). Organ lung weightsand lung weight to body weight ratios are common parameters used toassess potential toxicological responses to inhaled materials. Overall,the data are in line with historical data and indicate that there wasnot a response with either of these endpoints.

Bioanalytical

Results are summarized below in Table 19. Average paclitaxelconcentration in plasma was 16.705 ng/mL at 0.5 hours post exposure,then decreased gradually through the 24 hour timepoint and was below thelower limit of quantification (1 ng/mL) for all subsequent timepoints.Average paclitaxel concentration in lung tissue was 21940 ng/g at 0.5hours post exposure and decreased gradually to 419.6 ng/g by the 168hour timepoint. This indicates significant NanoPac® retention in thelung with minimal systemic exposure.

TABLE 19 Lung tissue and plasma results Lung Plasma Lung Tissue PlasmaTissue Average Average Time- Concen- Concen- Conc. Conc. Animal pointtration tration (ng/mL) Per (ng/g) Per Number (hr) (ng/mL) (ng/g)timepoint timepoint 1001 0.5 8.81 16680 16.705 21940 1002 24.6  272001003 6 4.46 7800 4.695 7160 1004 4.93 6520 1005 12 3.72 8240 3.720 63201006 <LLOQ 4400 1007 24 <LLOQ 3144 3.140 4452 1008 3.14 5760 1009 48<LLOQ 2300 <LLOQ 2652 1010 <LLOQ 3004 1011 72 <LLOQ 1760 <LLOQ 2028 1012<LLOQ 2296 1013 120 <LLOQ 608 <LLOQ 486.8 1014 <LLOQ 366 1015 168 <LLOQ572 <LLOQ 419.6 1016 <LLOQ 267

Conclusions

Sixteen (16) male Sprague Dawley rats were exposed to NanoPac®(paclitaxel; target dose of 0.37 mg/kg) by nose only inhalation on asingle occasion. Two animals (n=2) were euthanatized at 0.5, 6, 12, 24,48, 72, 120 and 168 hours post exposure for blood (plasma) and lungtissue collections.

The average Paclitaxel aerosol concentration of 73.5 μg/L during the 63minute inhalation exposure was ˜110% lower from target averagePaclitaxel aerosol concentration of 82.65 μg/L. The average exposureaerosol concentration was within ±15% of target aerosol concentrationwhich was expected for nebulized inhalation exposures. The particle sizedistribution was determined in terms of MMAD (GSD) for 6.0 mg/mLNanoPac® formulation aerosols using cascade impactor as 2.0 (2.2) μm.The recorded oxygen and temperature ranges were 19.7%-20.9% and 20.4°C.-20.8° C., respectively.

Paclitaxel deposited dose was calculated based on Paclitaxel averageaerosol concentration of 73.5 μg/L, average rodent body weight of 326 g,assumed deposition fraction of 10% and exposure duration of 63 minutes.The average achieved rodent deposited dose was determined to be 0.33mg/kg. The average achieved deposited dose was ˜11% lower when comparedto target deposited dose of 0.37 mg/kg due to expected variability (15%from target).

All animals survived to their planned necropsy timepoint. At necropsy,several animals had minimal, red discolorations on the lungs. No otherabnormal gross observations were noted at necropsy. From body and lungweights obtained at necropsy, average terminal bodyweight (standarddeviation) was 346.26 g (24.01); and average lung weight (standarddeviation) was 1.60 g (0.13). Organ lung weights and lung weight to bodyweight ratios are common parameters used to assess potentialtoxicological responses to inhaled materials. Overall, the data indicatethat there was not a response with either of these endpoints.

Average paclitaxel concentration in plasma was 16.705 ng/mL at 0.5 hourspost exposure, then decreased gradually through the 24 hour timepointand was below the lower limit of quantification at all timepoints after24 hours. Average paclitaxel concentration in lung tissue was 21940 ng/gat 0.5 hours post exposure and decreased gradually to 419.6 ng/g by the168 hour timepoint. This indicates significant NanoPac® retention in thelung with minimal systemic exposure. The following sampling timepointsare suggested for the PK study: 0.5 (+10 minutes), 6 (+10 minutes), 12(+10 minutes), 24 (+30 minutes), 48 (+30 minutes), 72 (+30 minutes), 120(+30 minutes) 168 (+30 minutes), 240 (+30 minutes) and 336 (+30 minutes)hours post exposure.

Example 12—NanoPac® (i.e.: (i.e.: Paclitaxel Particles as DisclosedHerein, Approximately 98% Paclitaxel with a Mean Particle Size (Number)of 0.83 Microns, a SSA of 27.9 m²/g, and a Bulk Density (not Tapped) of0.0805 g/Cm³) Inhalation Study in Rats—Low Dose and High Dose Summary

The overall objective of this work was to conduct nose-only inhalationexposure to male rats with NanoPac® suspension formulations of 6.0 mg/mLand 20.0 mg/mL. Rat inhalation exposures were conducted for 65 minuteseach.

NanoPac® suspension formulation of 6.0 mg/mL and 20.0 mg/mL wereprepared as per instructions provided by the sponsor. Two Hospitakcompressed air jet nebulizers were used simultaneously at 20 psi foraerosolization of NanoPac® formulation into the rodent inhalationexposure chamber. During each exposure, aerosol concentration wasmeasured from animal breathing zone by sampling onto 47-mm GF/A filtersat a flow rate of 1.0±0.5 L/minute. Particle size was determined bysampling aerosols from animal breathing zone using Mercer style cascadeimpactor at a flow rate of 2.0±0.1 L/minute. Filters were analyzedgravimetrically to determine total NanoPac® aerosol concentration andvia high performance liquid chromatography (HPLC) to determinePaclitaxel aerosol concentration for each exposure. Oxygen andtemperature were monitored and recorded throughout the inhalationexposures.

The average total NanoPac® aerosol concentration and Paclitaxel aerosolconcentration were determined to be 0.25 mg/L with a RSD of 7.43% and85.64 μg/L with a RSD of 10.23%, respectively for inhalation exposuresconducted with 6.0 mg/mL NanoPac® formulation. The measured average massmedian aerodynamic diameter (geometric standard deviation) using cascadeimpactor was 1.8 (2.0) μm for 6.0 mg/mL NanoPac® formulation aerosols.The average total NanoPac® aerosol concentration and Paclitaxel aerosolconcentration were determined to be 0.46 mg/L with a RSD of 10.95% and262.27 μg/L with a RSD of 11.99%, respectively for inhalation exposuresconducted with 20.0 mg/mL NanoPac® formulation. The measured averagemass median aerodynamic diameter (geometric standard deviation) usingcascade impactor was 2.3 (1.9) μm for 20.0 mg/mL NanoPac® formulationaerosols.

The average Paclitaxel deposited dose of 0.38 mg/kg and 1.18 mg/kg werecalculated using equation 1 for a 65 minute exposure for 6.0 mg/mL and20.0 mg/mL NanoPac® formulation, respectively.

Formulation and Inhalation Exposure Formulation Preparation Materials

Test Article: The test article used for inhalation exposure is shownbelow:

NanoPac®:

Identity: NanoPac® (sterile nanoparticulate Paclitaxel)Description: Novel dry powder formulation of Paclitaxel delivered as 306mg/vial

Vehicle

The vehicles used for preparation of NanoPac® formulations are shownbelow:

1% Polysorbate 80 Solution

Identity: Sterile 1% Polysorbate 80 in 0.9% sodium chloride forinjectionDescription: Clear liquid

Normal Saline Diluent

Identity: Sterile 0.9% sodium chloride for injection, USPDescription: Clear liquid

Formulation and Inhalation Exposure Formulation Preparation

NanoPac® formulation of 6.0 mg/mL was prepared as follows: Briefly, 5.0mL of 1% Polysorbate 80 was added to the vial containing NanoPac® (306mg, particles. NanoPac® vial was shaken vigorously and inverted toensure wetting of all particles present in the NanoPac® vial.Immediately after shaking, 46 mL of 0.9% Sodium Chloride solution wasadded to the NanoPac® vial and vial was shaken for at least 1 minute tomake sure sufficient mixing and proper dispersion of suspension.

The NanoPac® formulation procedure described above for 6.0 mg/mLformulation was used to prepare 20.0 mg/mL NanoPac® formulation with anexception of 10.3 mL of 0.9% sodium chloride solution was added to theNanoPac® vial instead of 46 mL used for 6.0 mg/mL formulation.

Resultant formulations were left undisturbed for at least 5 minutes toreduce any air/foam in the vial before placing it in nebulizer foraerosolization work. The final formulation of 6.0 mg/mL was kept at roomtemperature and nebulized within 2 hours after reconstitution. The finalformulation of 20.0 mg/mL was kept at room temperature and nebulizedwithin 30 minutes after reconstitution.

Exposure System Set-up/Aerosol Generation: As in example 11

Aerosol Concentration Monitoring: As in Example 11 Particle SizeDistribution: As in Example 11 Deposited Dose Calculation: As in Example11 Results Aerosol Concentration and Particle Size

Aerosol concentration was monitored throughout each NanoPac® formulationaerosol exposure using 47-mm GF/A filters from breathing zone of theanimals on nose-only exposure chamber. Seven 47-mm GF/A filters weresampled during each exposure. Filters FS-1 through FS-6 were sampled for10 minutes each and filter FS-7 was sampled for 5 minutes during eachlow and high dose groups. Particle size was measured using Mercer stylecascade impactor from animal breathing zone on the exposure chamber.Tables 20 and 21 show total and Paclitaxel aerosol concentrationsmeasured by sampling GF/A filters during low dose and high doseexposures, respectively.

TABLE 20 Aerosol concentrations during FY17- 008B low dose inhalationexposure. Total Aerosol Paclitaxel Aerosol Filter ID Conc. (mg/L) Conc.(μg/L) FS-1-L 0.247 80.05 FS-2-L 0.242 81.79 FS-3-L 0.252 87.09 FS-4-L0.296 104.38 FS-5-L 0.247 78.47 FS-6-L 0.249 82.50 FS-7-L 0.244 85.19Average 0.25 85.64 SD 0.02 8.76 % RSD 7.43 10.23

TABLE 21 Aerosol concentrations during FY17- 008B high dose inhalationexposure. Total Aerosol Paclitaxel Aerosol Filter ID Conc. (mg/L) Conc.(μg/L) FS-1-H 0.383 212.53 FS-2-H 0.412 239.28 FS-3-H 0.494 291.44FS-4-H 0.516 296.56 FS-5-H 0.456 254.67 FS-6-H 0.501 289.50 FS-7-H 0.431251.88 Average 0.46 262.27 SD 0.05 31.45 % RSD 10.95 11.99

The particle size (aerosol droplet size) distribution was determined interms of MMAD (Median of the distribution of airborne particle mass withrespect to the aerodynamic diameter) (GSD; accompanies the MMADmeasurement to characterize the variability of the particle sizedistribution) for each NanoPac® formulation aerosols using cascadeimpactor. For 6.0 mg/mL and 20.0 mg/mL NanoPac® aerosols the MMAD (GSD)were determined to be 1.8 (2.0) μm and 2.3 (1.9) μm, respectively. FIGS.9 and 10 show particle size distribution for 6.0 mg/mL and 20.0 mg/mLNanoPac® formulations aerosols, respectively.

Deposited Dose

Paclitaxel deposited dose was calculated based on Paclitaxel averageaerosol concentration, average rat body weight, assumed depositionfraction of 10% and exposure duration of 65 minutes for each low doseand high dose NanoPac® formulation exposures by using equation 1. Table22 shows average Paclitaxel aerosol concentration, average rat bodyweight, exposure time and deposited dose for each exposure. The averageachieved rodent deposited dose was determined to be 0.38 mg/kg and 1.18mg/kg for 6.0 mg/kg and 20.0 mg/kg NanoPac® formulation exposures,respectively.

TABLE 22 Paclitaxel deposited dose for low and high dose NanoPac ®inhalation exposures. Paclitaxel NanoPac ® Avg. Formulation Aerosol Avg.Rat Exposure Deposited Dose Conc. Conc. Weight Time Dose Level (mg/mL)(μg/L) (g) (min.) (mg/kg) Low 6.0 85.64 420.4 65 0.38 High 20.0 262.27420.5 65 1.18

Oxygen and Temperature

Oxygen and temperature were monitored throughout the NanoPac®formulation aerosols exposures. The recorded oxygen and temperatureranges were 19.8%-20.9% and 20.7° C.-20.8° C., respectively for 6.0mg/mL NanoPac® exposure. For 20.0 mg/mL NanoPac® formulation exposure,the recorded oxygen value was 19.8% throughout the exposure andtemperature range was 20.7° C.-20.8° C.

Preliminary Data: See FIGS. 11 and 12. Example 13—Evaluating Efficacy ofInhaled Nanopac® (i.e.: Paclitaxel Particles as Disclosed Herein,Approximately 98% Paclitaxel with a Mean Particle Size (Number) of 0.83Microns, a SSA of 27.9 m²/g, and a Bulk Density (not Tapped) of 0.0805g/Cm³) in the Nude Rat Orthotopic Lung Cancer Model—Study FY17-095Executive Summary

One hundred twenty-seven (127) NIH-mu Nude Rats were x-irradiated toinduce immunosuppression on Day −1. On Day 0 animals were dosed withCalu3 tumor cells by intratracheal (IT) instillation. Animals underwenta growth period of three weeks. During the third week, animals wererandomized by body weight stratification into 5 study groups. StartingWeek 4, animals in Group 2 received a once weekly dose of Abraxane® byintravenous (IV) dosing (5 mg/kg) on Days 22, 29 and 36. Animals inGroups 3 and 4 received once weekly (Monday) inhalation (INH) dose ofNanoPac® at low (0.5 mg/kg) and high (1.0 mg/kg) target doses,respectively. Animals in Groups 5 and 6 received a twice weekly (Mondayand Thursday) target inhalation dose of NanoPac® at low (0.50 mg/kg) andhigh (up to 1.0 mg/kg) doses respectively. Animals in Group 1 were leftuntreated as a control of normal tumor cell growth. All animals werenecropsied during Week 8.

All animals survived to their designated necropsy timepoint. Clinicalobservations related to the model included skin rash and laboredbreathing. All groups gained weight at about the same rate throughoutthe course of the study.

The inhalation exposure average Paclitaxel aerosol concentration foronce weekly Low Dose and twice weekly Low Dose NanoPac® groups was270.51 μg/L and 263.56 μg/L, respectively. The inhalation exposureaverage Paclitaxel aerosol concentration for once weekly High Dose andtwice weekly High Dose NanoPac® groups was 244.82 μg/L and 245.76 μg/L,respectively.

Doses were based on average aerosol paclitaxel concentration, mostrecent average group bodyweight, the assumed deposition fraction of 10%,and an exposure duration of 33 (Low-Dose) or 65 (High-Dose) minutes.During four weeks of treatment, the average achieved rodent depositeddose for the once weekly Low Dose NanoPac® group and twice weekly LowDose NanoPac® group were 0.655 mg/kg and 0.640 mg/kg (1.28 mg/kg/week),respectively. The average achieved rodent deposited dose for the onceweekly High Dose NanoPac® group and twice weekly High Dose NanoPac®group were 1.166 mg/kg and 1.176 mg/kg (2.352 mg/kg/week), respectively.For the group receiving IV injections of Abraxane®, the average dose onDay 22, 29 and 36 was 4.94, 4.64 and 4.46 mg/kg respectively.

At scheduled necropsy, the majority of animals from each group had tannodules on the lungs and/or red or tan patchy discolorations of thelung. Other sporadic observations included an abdominal hernia in oneanimal and a nodule on the pericardium in another animal. No otherabnormal gross observations were noted at necropsy.

In the Abraxane treated animal's lung weights, the lung to BW ratios andlung to brain weight ratios were significantly lower compared toUntreated Controls. The once weekly NanoPac® High Dose group had similarweights to the Abraxane group and significantly lower lung weights andlung to brain ratios compared to Untreated Controls.

Histologically, lungs of the majority of animals in all groups containedsome evidence of tumor formation. Tumor formation was characterized bythe presence of expansile variably sized small masses randomly scatteredwithin the lung parenchyma and larger expanded and coalescing massesthat effaced up to 75% of the lung parenchyma, smaller airways and bloodvessels. The larger masses were distributed primarily in the hilarregions or juxtaposed at the axial airway and the smaller masses weregenerally located peripherally.

The primary morphologic cellular characteristics of the lung tumormasses varied from the presence of undifferentiated to a fairly welldifferentiated pattern of adenocarcinoma of the lung. The predominanttumor cell type showed an undifferentiated adenocarcinoma morphology;the cells were pleomorphic, large, anaplastic, pale amphophilic-stainingwith fine intracytoplasmic vacuoles resembling mucoid vesicles,exhibited moderate to marked anisokaryosis, and were observed to beindividualized or growing in sheets and lacking clear-cut featurestowards differentiation to adenocarcinoma. However, the cellularmorphologic characteristics that were observed within other masses orgrowing within the previously described undifferentiated masses weremore organized and consistent with well differentiated lungadenocarcinoma demonstrating clear acinar gland differentiation. Theseamphophilic staining tumor cells were primarily arranged in nests orglandular patterns which were observed to be bound by alveolar septae.Mitotic figures were rarely observed in this tumor cell population. Lessfrequently observed within these masses were focal areas ofprimitive-appearing relatively small Primitive Tumor Cells with small tomoderate amounts of pale basophilic staining cytoplasm, ovoid andvariably vesicular nuclei, and moderate anisokaryosis. These PrimitiveTumor Cells were observed to be growing randomly and in sheets.Increased numbers of mitotic figures and apoptotic bodies were notedmost often in this basophilic Primitive Tumor Cell population.Inflammation, characterized by mixed inflammatory cell (predominatelyeosinophils, lymphocytes, foamy macrophages and the occasional giantcell) infiltration accompanied by interstitial fibrosis was commonlyobserved. Significant parenchymal necrosis was uncommon to absent.

The pathologist considered the presence of scalloping of the edges ofthe individual tumor masses characterized by gradual loss of tumorcells, to complete loss of tumor cells with residual fibrosis connectivetissue scaffolding of the lung parenchyma and accompanied by invasion offoamy macrophages to be evidence of Tumor Regression.

Compared to the positive control Grp. 1 and the Abraxane treatedcomparative Grp. 2, there was a decreased overall lung tumor burden inthe NanoPac® treated groups (Grp. 3-6) characterized by a decrease inthe severity of adenocarcinoma tumor masses and Primitive Tumor Cellpopulation as well as evidence of Tumor Regression. No othertreatment-related lesions or findings were observed. Extensivemononuclear cell infiltration was observed in the lungs of animalsreceiving NanoPac® through inhalation. As the model used is T celldeficient, it is likely that the cells are B cells or NK cells. It ishypothesized that the localized, likely higher concentration exposure ofthe tumor to NanoPac® affected the tumors leading to an alteration inthe environment to draw the mononuclear cellular infiltrate into thelung.

Objectives

The objective of this study was to evaluate the efficacy of inhaledNanoPac® formulation compared to a clinical reference dose ofintravenous administered Abraxane in reducing tumor burden in anorthotopic model of lung cancer.

Materials and Methods Test System Species/Strain: NIH-mu Nude Rats

Age of Animals at Study Start: 3-5 weeks old

Body Weight Range at Study Start: Approximately 150-200 g

Number on Study/Sex: 127 Males (120 study animals and 7 spares)

Source: Envigo

Identification: Permanent maker tail marking

Abraxane Formulation

The clinical reference material used for IV formulation was the drugproduct Abraxane®. The drug product was reconstituted to 5.0 mg/mL withsaline on the day of dosing and was stored per manufacturer'sinstructions.

NanoPac® Formulation

The 20.0 mg/ml NanoPac® formulations for exposures were prepared per thesponsor recommendations. Specifically, the NanoPac® was reconstitutedwith 1% polysorbate 80. The vial was shaken by hand until all particleswere wetted. Additional 0.9% sodium chloride for injection was added (tothe desired concentration target) and the vial was shaken by hand foranother minute. Shaking continued until no large clumps were visible andthe suspension was properly dispersed.

Resultant formulations were left undisturbed for at least 5 minutes toreduce any air/foam in the vial before placing it in a nebulizer foraerosolization work. The final formulation was kept at room temperatureand nebulized within 2 hours after reconstitution. The final 20.0 mg/mLwas kept at room temperature and nebulized within 30 (+5) minutes afterreconstitution.

Experimental Design

One hundred twenty-seven (127) animals were used for study. Prior tox-irradiation and dosing of tumor cells, 7 animals were designated asspares (spare animals did not have irradiations or cell lineinstillations). On Day −1 all study animals were x-irradiated to induceimmunosuppression. On Day 0 animals were dosed with Calu3 tumor cells byintratracheal (IT) instillation. Animals underwent a growth period ofthree weeks. During the third week, animals were randomized by bodyweight stratification into the groups outlined in Table 23 below.Starting Week 4, animals in Group 2 received a once weekly target doseof Abraxane® by intravenous (IV) dosing (5 mg/kg). Animals in Groups 3and 4 received once weekly (Monday) inhalation (INH) target dose ofNanoPac® at low (0.5 mg/kg) and high (1.0 mg/kg) doses, respectively.Animals in Groups 5 and 6 received a twice weekly (Monday and Thursday)inhalation target dose of NanoPac® at low (0.50 mg/kg) and high (1.0mg/kg) respectively. Animals in Group 1 were left untreated as a controlof normal tumor cell growth. All animals were necropsied during Week 8.

TABLE 23 Experimental Design Target Dose Group Cell and TreatmentExposure Description N= Irradiation Line Route Frequency* FormulationDuration Necropsy* 1 Control 20 Day-1 Calu N/A N/A N/A N/A Week 8 2 IV20 3, IT IV up to 5 Abraxane N/A Abraxane instillation mg/kg** (5 mg/ml)3 NanoPac ® 20 Day 0 INH 0.5 mg/kg, 20.0 mg/mL 33 min Low Once onceweekly NanoPac ® Weekly (1×) 4 NanoPac 20 INH 1.0 mg/kg, 20.0 mg/mL 65min High Once once weekly NanoPac ® Weekly (1×) 5 NanoPac  ® 20 INH 0.5mg/kg, 20.0 mg/mL 33 min Low- Twice twice NanoPac ® Weekly (2×) weekly 6NanoPac 20 INH 1.0 mg/kg, 20.0 mg/mL 65 min High Twice twice NanoPac ®Weekly (2×) weekly *Treatment occurred during Week 4-8. Necropsyoccurred during Week 8. **Abraxane ® target dose: 5.0 mg/kg based onbodyweight; target dose volume: not to exceed 250 μL, frequency: Day 1,8, and 15 of each 21 day cycle beginning during Week 4.

Husbandry, Quarantine and Assignment to Study

After quarantine all animals were weighed and randomized to remove the 7spares based on body weights. From Week 1 to Week 3 animals wereidentified by cage cards (LC numbers) and tail markings.

During Week 3, prior to beginning treatment, animals were weighed andrandomized into the groups listed above by body weight stratificationand assigned a Study ID. From this point forward, animals wereidentified by cage cards and sharpie tail marking.

Immunosuppression and Irradiation

On Day −1, animals underwent whole body x-ray exposure with ˜500 rads(Phillips RT 250 X-ray Therapy Unit, Phillips Medical Systems, Shelton,Conn.) set at 250 kVp, 15 mA, and a source-to-object distance of 100 cm.The animals were placed in a pie chamber unit, 2-3 animals per slice ofpie. The irradiation process took ˜10-15 minutes.

Tumor Cell Implantation

On Day 0, animals received tumor cells (Calu3) administered by IT.Briefly, after being anesthetized by 3-5% isoflurane in an inductionchamber, the animal was placed with upper incisors hooked on an inclinedhanging instillation platform. The animals tongue was gently securedwhile the stylet is inserted just past the larynx and into the trachea.A volume of cells in EDTA suspension (target dose volume: 500 μL;concentration: approximately 20×106 per 0.5 mL) was delivered to thelungs via intratracheal instillation. After the instillation, theanimals' breathing and movement was monitored carefully. Following tumorcell implantation, animals underwent a tumor growth period ofapproximately 3 weeks prior to treatment to allow for tumor cellengraftment and the development of lung cancer.

Calu3 Growth and Preparation

Calu3 cells were grown at 37° C. with 5% CO2 in cell culture flasks.They were grown in Roswell Park Memorial Institute (RPMI) 1640 mediawith 10% fetal bovine serum (FBS) until 80% confluence. Cells weremaintained until the day of instillation. Prior to instillation theywere harvested by washing with PBS, then trypsin was added to removecells from the flask. The cells were neutralized with RPMI 1640 mediacontaining 10% FBS. They were then centrifuged at 100×g for 5 minutes;the media was removed and the cells were resuspended to a concentrationof 20 million cells in 450 μL of serum free RPMI. Prior to instillation,50 μL of 70 μM EDTA was added to the cell suspension for a total IT dosevolume of 500 μL per rat.

Body Weights and Daily Observations

Body weights were collected for randomization, weekly through Week 3,twice weekly beginning at Week 4 through the end of the study, and atnecropsy.

Each animal on study was observed twice daily for any clinical signs ofabnormality, morbidity or death. Technicians observed animals duringdosing and bodyweight sessions.

Abraxane Administration IV-Tail Vein Injections

Abraxane (5 mg/mL, maximum dose volume of 250 μL) was administered toanimals in Group 2 by IV tail vein injection on Days 22, 29 and 36.

NanoPac® Administration—Nose-only Aerosol Exposures Conditioning

Animals were conditioned to nose-only exposure tubes for up to 70minutes. Three conditioning sessions occurred over three days prior toexposure, with the first session lasting 30 minutes, the second 60minutes and the third 70 minutes. They were monitored closely throughoutthe conditioning periods and during exposures to assure that they didnot experience more than momentary distress.

Exposure System

Aerosols were generated with two compressed air jet Hospitak at anebulizer pressure of 20 psi. NanoPac® suspension formulation of 20.0mg/mL was used for low dose and high dose exposures. Aerosols weredirected through a delivery line into a 32-port nose-only exposurechamber. The rodent inhalation exposures were conducted for 33 or 65minutes. NanoPac® suspension aerosol was generated with a set of twoHospitak compressed air jet nebulizers (used for up to 40 (±1) minutes),then replaced with a second set of two Hospitak nebulizers for remainingexposure duration. Oxygen and temperature were monitored and recordedthroughout each inhalation exposure

Concentration Monitoring

Aerosol concentration monitoring was conducted by collecting aerosolsonto pre-weighed GF/A 47-mm filters. The filters were sampled fromanimals breathing zones of the nose-only exposure chamber throughouteach inhalation exposure. The aerosol sampling flow rate through GF/Afilters was maintained at 1.0±0.5 L/minute. Filters were collectedthroughout each exposure duration every 10-minutes except for the lastfilter. With the low-dose exposures (groups 3 and 5) lasting 33 minutes,the final filter was collected after 13 minutes and with the high-doseexposures (groups 4 and 6) lasting 65 minutes, the final filter wascollected after 15 minutes. After sample collection filters were weighedto determine the total aerosol concentration in the exposure system.

Post weighing, each filter was placed in a 7 mL glass vial. The filtersin glass vials were extracted and analyzed by High Performance LiquidChromatography (HPLC) to quantify the amount of Paclitaxel collectedonto the filters. The total aerosol concentration and Paclitaxel aerosolconcentrations were calculated for each filter by dividing the totalamount of aerosols and Paclitaxel aerosols collected with total air flowthrough the filter. The average Paclitaxel aerosol concentration wasused to calculate the achieved average deposited dose of Paclitaxel tothe rodent lungs using Equation 1 as shown in the Determination of Dosesection below.

Determination of Dose

Deposited dose was calculated using Equation 1 same as in Example 4

Euthanasia and Necropsy

At scheduled necropsy, animals were euthanized by intraperitonealinjection of an overdose of a barbiturate-based sedative.

Blood and Tissue Collection

For all necropsies a terminal body weight and brain weight wascollected. For scheduled euthanasia blood (for plasma) was collected bycardiac puncture into a K2EDTA tube. The lungs were removed and weighed.A section of lung tissue containing a tumor, a tracheobronchial lymphnode, was frozen in liquid nitrogen for potential future analysis. Theremaining lung was fixed for potential histopathology.

Histopathology

Fixed left lung lobes were trimmed in a “bread loaf” manner andalternate sections were placed in 2 cassettes to yield 2 slides eachwith 3 representative sections of the left lung. Tissues were processedroutinely, paraffin embedded, sectioned at ˜4 μm, mounted, and stainedwith hematoxylin and eosin (H&E) for microscopic examination. Findingswere graded subjectively, semi-quantitatively.

Sections of lung (1-4/animal) obtained from 60 out of the 120 treatednude rats on study, trimmed longitudinally, were processed to H&Estained glass slides for light microscopic evaluation.

During this review, the microscopic findings were recorded and thentransferred to an electronic pathology reporting system(PDS-Ascentos-1.2.0, V.1.2), which summarized the incidence andseverities of the lung burden characteristics data and tabulated theresults and generated the individual animal data. The lungs from the 60nude rats were examined histologically: Group 1 [1001-1010], Group 2[2001-2010], Group 3 [3001-3010], Group 4 [4001-4010], Group 5[5001-5010] and Group 6 [6001-6010]). In order to assess the level oftumor burden in these lungs, the lungs were evaluated and scored duringhistopathologic examination. For each cumulative lung burdencharacteristic diagnosis: 1) Adenocarcinoma (undifferentiated anddifferentiated), 2) Primitive Tumor Cells (poorly differentiatedpleomorphic cells) and 3) Tumor Regression, the lungs were gradedsemi-quantitatively using a 4-point grading scale indicating the percentinvolvement of the overall lung tissue provided as follows: 0=noevidence, 1=minimal (˜1-25% total area of lung sections involved),2=mild (˜25-50% total area of lung sections involved), 3=moderate(˜50-75% total area of lung sections involved), and 4=marked (˜75-100%total area of lung sections involved).

Histomorphometry

Histomorphometric analyses was performed using fixed left lung lobes ofthe first 10 animals from each group. Tissue was trimmed using amorphometry (“bread slice”) style trim. Briefly, trimming started at arandom point between 2 and 4 mm from the cranial end of the lung. Eachlung section was cut approximately 4 mm thick. Odd numbered sectionswere placed caudal side down in cassette 1 while even numbered sectionswere placed in cassette 2. Tissue sections were then processed, paraffinembedded, and sectioned at 4 μm and stained with hematoxylin and eosin(H&E) for examination. Both slides (odd and even slices) were used todetermine an average tumor fraction per animal.

Morphometric analysis was performed on the hematoxylin and eosin (H&E)stained lung tissue from the designated animals by Lovelace Biomedical.Whole slides (2 per animal containing transverse sections of the entireleft lung) were scanned using a Hamamatsu Nanozoomer™. Scans wereanalyzed with Visiopharm Integrator System software (VIS, version2017.2.5.3857). Statistical analysis of tumor area fraction wasperformed in GraphPad Prism 5 (version 5.04).

Computerized image quantification designed to quantify the amount oftumor area present on each slide was performed on all left lung tissueusing the whole slide scans. The Visiopharm Application for quantifyingthe area of lung metastases was used to differentiate tumor cells fromnormal lung tissue based on cell density, staining intensity, and sizeand staining intensity. It is noted that this quantitation based uponsimple H&E staining will not be perfect (i.e. it is not capable of fullydiscriminating between types of tumor tissue, necrotic and viable tumortissue, and some normal structures may be included as tumor). The valuein application of this process to H&E sections is that it is an unbiasedapproach to tumor quantification. The area of the whole piece of lung isdetermined, and the area occupied by structures identified as metastasesis then expressed as a percentage of the total area. Minor adjustment ofthe area to be analyzed to ensure extrapulmonary structures are excludedand the entire lung is included may be performed manually. Other manualmanipulations are avoided in order to ensure consistency across allgroups and remove potential for introduction of bias. If possible,development of specific immunohistochemical stains to identify onlytumor tissue would increase specificity of this analysis.

Blood Collection and Processing

Blood collected at necropsy was processed to plasma by centrifugation ata minimum of 1300 g at 4° C. for 10 minutes. Plasma samples were storedat −70 to −90° C. until analysis or shipment to sponsor.

Additional Morphologic and Immunohistochemical (Ihc) Studies

A subset of 17 animals was chosen to review morphologic andimmunohistochemical (IHC) features using slides prepared withHematoxylin & Eosin, Masson's Trichrome, AE1/AE3 (pan-keratin), andCD11b (dendritic cells, natural killer cells and macrophages). Thissubset included Control animals (n=2) and Treated animals from eachtreatment group (n=3 per group). Rat lung blocks were sectioned at 4 μmthickness and collected on positively charged slides.

Methods

H&E and Masson's trichrome staining were performed according to standardprotocols. For Anti-Pan Cytokeratin antibody [AE1/AE3], rat uterus wassectioned from a tissue bank as controls. Optimization was performed onformalin-fixed paraffin-embedded (FFPE) rat uterus tissue from thetissue bank using a Leica Bond automated immunostainer and a mouseAnti-Pan Cytokeratin [AE1/AE3] (Abcam, #ab27988, Lot #GR3209978-1)antibody at four different dilutions plus a negative control: no primaryantibody, 1:50, 1:100, 1:200, and 1:400. Heat induced antigen retrievalwas performed using Leica Bond Epitope Retrieval Buffer 1 (CitrateBuffer solution, pH6.0) for 20 minutes (ER1(20)) and Leica Bond EpitopeRetrieval Buffer 2 (EDTA solution, pH9.0) for 20 minutes (ER2(20)).Non-specific background was blocked with Rodent Block M (Biocare,#RBM961H, Lot #062117).

Anti-pan Cytokeratin antibody [AE1/AE3] antibody was detected usingMouse-on-Mouse HRPPolymer (Biocare, #MM620H, Lot #062016) and visualizedwith 3′3-diaminobenzidine (DAB; brown). A Hematoxylin nuclearcounterstain (blue) was applied. Optimization slides were examined, andoptimal staining conditions for sample slides were determined withAnti-Pan Cytokeratin antibody [AE1/AE3] at 1:50 dilution with ER2(20).

For Anti-CD-11b antibody, optimization was performed on formalin-fixedparaffin-embedded (FFPE) rat lymph nodes tissue from a tissue bank usinga Leica Bond automated immunostainer and a rabbit anti-CD11b antibody atfour different dilutions plus a negative control: no primary antibody,1:250, 1:500, 1:1000 and 1:2000.

Heat induced antigen retrieval was performed using Leica Bond EpitopeRetrieval Buffer 1 (Citrate Buffer, pH6.0) for 20 minutes (ER1(20)) orLeica Bond Epitope Retrieval Buffer 2 (EDTA solution, pH9.0) for 20minutes (ER2(20)).

Anti-CD11b antibody was detected using Novocastra Bond Refine PolymerDetection and visualized with 3′3-diaminobenzidine (DAB; brown). AHematoxylin nuclear counterstain (blue) was applied. Optimization slideswere examined, and optimal staining conditions for FFPE tissue weredetermined with anti-CD11b at 1:2000 dilution with ER2(20). Rat lymphnodes controls were used alongside rat lung samples.

Study Results Clinical Observation, Survival, and Bodyweights

All animals survived to their designated necropsy timepoint. Clinicalobservations related to the model included skin rash and laboredbreathing. One animal was observed to have an upper abdominal hernia.Per vet recommendation the animal was switched with a Group 1 (UntreatedControl) that would not undergo inhalation exposures therefore noexposure tube restraint would be necessary.

FIG. 13 shows the average body weights through the duration of thestudy. FIG. 14 shows the percent change in average body weights from Day0. All groups gained weight at about the same rate through the course ofthe study.

Abraxane IV Tail Vein Injections

For the group receiving IV injections of Abraxane, the average dose onDay 22, 29 and 36 was 4.94, 4.64 and 4.46 mg/kg respectively.

NanoPac® Exposures Aerosol Concentrations and Deposited Dose

Total aerosol and Paclitaxel aerosol concentrations were measured bysampling of GF/A filters during each exposure. The inhalation exposureaverage Paclitaxel aerosol concentration for once weekly Low Dose andtwice weekly Low Dose NanoPac® groups was of 270.51 μg/L and 263.56μg/L, respectively. The inhalation exposure average Paclitaxel aerosolconcentration for once weekly High Dose and twice weekly High DoseNanoPac® groups was of 244.82 μg/L and 245.76 μg/L, respectively. Theoxygen and temperature levels were monitored throughout each exposure.

Doses were based on average aerosol paclitaxel concentration, mostrecent average group bodyweight, the assumed deposition fraction of 10%and an exposure duration of 33 or 65 minutes. During four weeks oftreatment, the average achieved rodent deposited dose for the onceweekly Low Dose NanoPac® group and twice weekly Low Dose NanoPac® groupwere 0.655 mg/kg and 0.640 mg/kg (1.28 mg/kg/week), respectively.

The average achieved rodent deposited dose for the once weekly High DoseNanoPac® group and twice weekly High Dose NanoPac® group were 1.166mg/kg and 1.176 mg/kg (2.352 mg/kg/week), respectively.

Particle Size (MMAD & GSD)

The particle size distribution was determined in terms of Mass MedianAerodynamic Diameter (MMAD) and Geometric Standard Deviation (GSD) foreach NanoPac® formulation aerosols using cascade impactor. For the 20.0mg/mL NanoPac® aerosols the average MMAD was determined to be 2.01 μmand a GSD of 1.87.

Necropsy Observations and Organ Weights

All animals survived to their designated necropsy timepoint. At necropsyanimals from each group had tan nodules on the lungs and/or red or tanpatchy discolorations of the lung. Other sporadic observations includedan abdominal hernia in one animal and a nodule on the pericardiuminanother animal. No other abnormal gross observations were noted atnecropsy. One animal did not have any visible tumors (nodules) at thetime of necropsy.

Individual animal organ weight data is shown graphically in FIG. 15 ,FIG. 16 and FIG. 17 . In Abraxane treated animal's lung weights, lung toBW ratios and lung to brain weight ratios were significantly lowercompared to Untreated Controls. The once weekly NanoPac® High Dose grouphad similar weights to the Abraxane group and significantly lower lungweights and lung to brain ratios compared to Untreated Controls. Theonce weekly Low Dose, NanoPac® twice weekly Low Dose and twice weeklyHigh Dose NanoPac® groups generally had similar average lung weights andratios.

Morphometry

All treatment groups showed a decrease in average lung tumor fractionwhen compared to the control group; however, there was no statisticallysignificant difference between groups. There was also no statisticallysignificant difference between IV Abraxane treatment and any of theNanoPac® treatment regimens in regards to the tumor area fractionexamined on cross sectional lung slides. As is typical of this model,there is wide variability between animals within all groups in the tumorfraction. These data should be considered in combination with otherindicators of lung tumor burden in this model including lung to brainweight ratios and standard histopathology for final interpretation. Itis important to note that morphometric analysis and histopathologicexamination was performed on fixed lung tissue from the left lobe whileother analyses on lung tissue may be performed on frozen tissue from theright lung lobes. Average tumor area is shown in FIG. 18 and FIG. 19 .

Pathology Results

H&E Stained lung slides are shown in FIGS. 20, 21, 22, 23, 24, and 25 .As a result of the slide examination of the identified populations ofneoplastic cells, the pathologist determined: (1) There was a slightdecrease in severity of an overall lung tumor burden of Adenocarcinoma(undifferentiated and differentiated cells) in all treated groups (Grp.2 (1.7), Grp, 3 (1.8), Grp. 4 (1.7), Grp 5 (1.6) and Grp. 6 (1.6)compared to the untreated Control Grp. 1 (2.1). (2) There was reductionin the Primitive Tumor Cell population evident by a decrease in theseverity in Grp. 3 (0.3), Grp. 4 (0.3), Grp 5 (0.2) and Grp 6 (0.2)compared to the corresponding control Grp 1 (0.9) and Grp 2 (1.0), and3). There was Tumor Regression present in Grp 3 (0.6), Grp 4 (1.0), Grp5 (0.8) and Grp 6 (1.0) compared to the corresponding control Grp 1(0.0) and Grp 2 (0.1). The incidence and severities of the lung burdencharacteristics data are summarized in Table 24, and in FIG. 26 .

TABLE 24 Incidences and Severities of Cumulative Lung Burden GROUPS 1 23 4 5 6 Control IV Abraxane Low 1× High 1× Low 2× High 2× 1001- 2001-3001- 4001- 5001- 6001- Animal Nos. 1010 2010 3010 4010 5010 6010 LUNG(NO. EX) (10)  (10)  (10)  (10)  (10)  (10)  Adenocarcinoma 10  10  10 9 10  10  Minimal  2ª 4 5 3 5 5 Mild 5 5 2 4 4 3 Moderate 3 1 3 2 1 2Marked  0^(b) 0 0 0 0 0 Average Severity   2.1   1.7   1.8   1.7   1.6  1.7 Grade Primitive Tumor 9 10 2 3 2 2 Cells Minimal 9 10 1 3 2 2 Mild0 0 1 0 0 0 Moderate 0 0 0 0 0 0 Marked 0 0 0 0 0 0 Average Severity  0.9   1.0   0.3   0.3   0.2   0.2 Grade Tumor Regression 0 1 6 5 6 5Minimal 0 1 6 3 5 2 Mild 0 0 0 0 0 2 Moderate 0 0 0 1 1 0 Marked 0 0 0 10 1 Average Severity 0   0.1   0.6   1.0   0.8   1.0 Grade ^(a)SeverityGrade is based on a 4-point grading scale of 1 to 4: 1 = minimal, 2 =mild, 3 = moderate, 4 = marked ^(b)The presence of a (0) indicates thatthere in no evidence histopathologically of the lesion in question

Observations of H&E Stained Lung slides are shown in FIGS. 20, 21, 22,23, 24, and 25 : General Observations:

Control: Extensive levels of viable tumor with proliferating cells andlittle to no immune cell infiltration.

Abraxane IV: Many viable appearing tumor masses with some lymphocyticresponse along with some tumor regression.

NanoPac® 1× per week, High: Clearance of tumor from the lung with fewviable tumor cells remaining. Masses remaining appear to be immune cellinfiltrate and fibrosis.

NanoPac® 2× per week, Low: Some remaining tumor nodules surrounded byimmune cell infiltrate including macrophages and mononuclear cells.

NanoPac® 2× per week, High: Few tumor nodules with immune infiltrate andstromal fibrosis replacing tumor.

Extensive mononuclear tumoricidal cell infiltration was observed in thelungs of animals receiving NanoPac® through inhalation. As the modelused is T cell deficient, it is likely that the cells are B cells or NKcells, or both. B cells are responsible for the production of antibodiesand can be involved in tumor cell killing through antibody-dependentcell mediated cytotoxicity (the antibodies bind to cells expressing FcReceptors and enhance the killing ability of these cells). NK cells areinnate lymphoid cells that are crucial in the killing of tumor cells. Inpatients with tumors, NK cell activity is reduced allowing for thegrowth of the tumor. Along with T cells, NK cells are the target of somecheck point inhibitors to increase their activity.

By the use of a wide array of surface receptors capable of deliveringeither triggering or inhibitory signals, NK cells can monitor cellswithin their environment to ascertain if the cell is abnormal (tumor orvirally infected) and should be eliminated through cytotoxicity.

The cytotoxicity and chemotaxis of NK cells can be modified by manypathological processes including tumor cells and their byproducts. Inresponse to certain signals their functions are enhanced or potentiated.In response to several Pathogen Associated Molecular Patterns (PAMPs) byusing different Toll Like Receptors (TLR); NK cells can increasecytokine production and/or cytolytic activity. Cytokines, includingIL-2, IL-15, IL-12, IL-18, and IFNs u/0 can also modify the activity ofNK cells. NK cells are not simple cells that are only cytolyticeffectors capable of killing different tumor cell targets; rather, theyrepresent a heterogeneous population which can finely tune theiractivity in variable environmental contexts.

The tumor burden seems to be significantly reduced in the lungs of theanimals treated with NanoPac® and is lower than that for Abraxane IV.Therefore, the localized administration of paclitaxel in the form ofNanoPac® provides additional potency. This is likely due to both thelonger exposure to the chemotherapy over time and the vigorous cellularinfiltration to the site of the tumor. This latter response appeared tobe dependent on the dose density (actual dose and dose frequency).Observations of Specific Photomicrographs:

FIG. 20 : Subject 1006 (Control) Adenocarcinoma-3, Primitive-1,Regression-0. Low-power magnification (2×) showing the generaldistribution of undifferentiated, pleomorphic, large, anaplastic tumorcells within alveolar spaces or lining the alveolar septae. The majorityof cells do not have features of adenocarcinoma and appear in sheets ofcontiguous tumor. Many cells have basophilic staining cytoplasm, whileothers are large, anaplastic and contain pale amphophilic-staining. Notethe presence of a pre-existing resident population of alveolarmacrophages and the absence of tumor regression.

FIG. 21 : Subject 2003 (IV Abraxane) Adenocarcinoma-1, Primitive-1,Regression-1. Low-power magnification (4×) showing the generaldistribution of tumor masses predominantly at the periphery as well asmultiple smaller expansive tumor masses filling alveolar spaces. Thetumor cells are pleomorphic, large, anaplastic and have paleamphophilic-staining, varying from undifferentiated to differentiatedpatterns of adenocarcinoma. Evidence of tumor regression is presentaround the periphery of the mass and primarily characterized by theinfiltration of macrophages.

FIG. 22 : Subject 2010 (IV Abraxane) Adenocarcinoma-3, Primitive-1,Regression-0. Low-power magnification (2×) showing the generaldistribution of large expansive tumor mass filling most alveolar spacesas well as neoplastic cells in the periphery. Most tumor cells arepredominantly undifferentiated, pleomorphic, large, anaplastic with paleamphophilic-staining. The primitive cells are smaller, ovoid, and havemore basophilic staining cytoplasm with variable, vesicular nuclei andmoderate to marked anisokaryosis. Inflammatory cell infiltration arepredominantly neutrophils and macrophages. This image demonstrates anabsence of tumor regression.

FIG. 23 : Subject 4009 (IH NanoPac® 1×/wk High) Adenocarcinoma-0,Primitive-0, Regression-4. Low-power magnification (2×) showing thegeneral distribution of previously populated tumor masses, the presenceof multiple small areas of fibrous connective tissue, centralcollagenous stroma and fibrocytes are seen at the peripheral alveolarspaces as well as thickened alveolar septae supports evidence of tumorregression. In addition, the alveolar spaces are commonly filled withinfiltrate of macrophages and lymphocytes together with additionalevidence of tumor regression.

FIG. 24 : Subject 5010 (IH NanoPac® 2×/wk Low) Adenocarcinoma-1,Primitive-0, Regression-3. Low-power magnification (2×) showing thegeneral distribution of previously populated tumor masses. Regressingmasses are variably small and randomly distributed. Fibrous connectivetissue is seen filling/replacing alveolar spaces and suggests foci ofregressing adenocarcinoma. Acute necrosis, fibrous connectivescaffolding, mixed cell infiltration of macrophages, giant cells andlymphocytes in the epithelium as well as around the stroma are signs oftumor regression.

FIG. 25 : Subject 6005 (IH NanoPac® 2×/wk High) Adenocarcinoma-1,Primitive-0, Regression-4. Low-power magnification (2×) showing thegeneral distribution of previously populated tumor masses in multiplesmall areas of fibrous connective tissue filling/replacing the alveolarspaces suggesting foci of previous infiltrates of adenocarcinoma cells.Tumor regression is evidenced by fibrosis of previously populated tumormasses, central collagenous stromal core and fibrous connective tissueat the periphery filling/replacing the alveolar spaces, thickening ofthe septae as well as the presence of fibrocytes filling the alveolarspace infiltrated by lymphocytes and macrophages.

Results of the Additional Morphologic and Immunohistochemical (IHC)Studies

After a review of H&E slides of all 120 animals in the study, it wasnoted that a possible immune response was seen in treatment groups. Tofurther investigate this finding, a subset of animals was chosen fromeach group for further immunohistochemical evaluation.

Firstly, the trend of tumor regression as evaluated by a pathologistreviewing all 120 animals was compared to a different pathologistreviewing a subset of 17 animals to show a similar trend between thesample sizes.

Initial evaluation of the degree of tumor regression on all 120 animalswas done via a pathologist grading semi-quantitively using a point scaleindicating the percent of involvement of the overall lung tissue. Thegrading system is based on a grading scale of: 0=no evidence, 1=1-25%total area of lung sections, 2=25-50% total area of lung sections,3=50-75% total area of lung sections, 4=75-100% total area of lungsections. This evaluation showed the incidence of animals presentingwith tumor regression scored as follows, 0% of non-treated controls, 10%of IV Abraxane, 55% of IH NanoPac® low-dose once weekly, 55% of IHNanoPac® low-dose twice weekly, 55% of IH NanoPac® high-dose once weeklyand 65% of IH NanoPac® high-dose twice weekly.

A review of the subset of 17 animals performed by a separate pathologistevaluating tumor regression using as similar semi-quantitative gradingscale (0=no evidence, 1=1-19% total area of lung sections, 2=11-50%total area of lung section, 3=greater than 50% total area of lungsections, 4=complete regression). This evaluation showed the incidenceof animals presenting with tumor regression scored as follows: 0% ofnon-treated controls, between 65-69% of IV Abraxane, 100% of IH NanoPac®low-dose once weekly, 100% of IH NanoPac® low-dose twice weekly, 100% ofIH NanoPac® high-dose once weekly and 100% of IH NanoPac® high-dosetwice weekly. This review (17 animals) presented a similar pattern tothe previous review (120 animals) with the inhaled groups showing thegreatest percent of animals with tumor regression.

Upon histological review of the subset of 17 animals from the study,interesting patterns with respect to tumor regression and immuneresponse were seen. Two main features differed amongst the variousgroups, notably the presence and degree of tumor regression and thepresence and intensity of an accompanying immune response. Below are theobservations and remarks of the histological review.

No Treatment Group

Observations: FIG. 27 : Control cases. Top row: H/E stained sections.Bottom row: Immunohistochemical staining.

-   -   Column 1: (A) Poorly differentiated area of adenocarcinoma        composed of sheets of large cells with pleomorphic nuclei,        increased mitoses and lack of glandular differentiation. Note        dense compact arrangement of tumor cells, sharp demarcation from        surrounding normal lung in lower right corner and the lack of a        fibrotic capsule surrounding the tumor. (D) Corresponding        keratin immunostain from same area shown in A. This demonstrates        sensitive and specific labeling of carcinoma cells with        pancytokeratin (solid arrow).    -   Column 2: (B) Adenocarcinoma with focal rudimentary duct        formation (dashed arrow at top right). Note the focal, limited        immune cell component in the center, consisting of small        lymphocytes and focal macrophages (solid arrows in center). (E)        CD11 b stain showing minimal numbers of NK cells and macrophages        at the periphery of a tumor cell nodule (solid arrow).    -   Column 3: (C) Adenocarcinoma growing adjacent to a focus of        bronchial associated lymphoid tissue (BALT) that consists of        densely packed small mature lymphocytes (marked with solid        arrow). Note the close association of the BALT with the adjacent        normal bronchial lining (dashed arrow top left corner). (F)        Corresponding focus to that seen in C, stained with keratin,        showing positive staining in carcinoma cells and lack of        staining in the lymphoid cells.

Remarks: Both animals presented uniform growth of solid, densely packedcollections of adenocarcinoma. The tumors had relatively well demarcatedmargins bordering the surrounding normal lung parenchyma with noevidence of tumor regression and unabated tumor cell growth. Thelymphoid infiltrate in these animals was mild and tertiary lymphoidstructures were sparse.

Intravenous (IV) Abraxane Positive Treatment Control Group

Observations: FIG. 28 : IV Abraxane case (2003) showing a nodule ofadenocarcinoma with tumor regression consisting of separation of thetumor towards the periphery of the nodule into progressively smallertumor cell clusters and single tumor cells, with an associated increasedimmune cell infiltrate.

-   -   Column 1: (A) Low power view of a nodule of invasive        adenocarcinoma (highlighted by dashed arrows). Note the        irregular peripheral border of the nodule due to progressive        separation of tumor cells at the periphery and increased immune        cell response (solid arrows). (D) Corresponding keratin        immunostain from same area shown in A. This clearly demonstrates        the progressively smaller size of tumor cell nodules toward the        periphery (dashed arrows) and the increased intervening stroma        between them (solid arrow).    -   Column 2: (B) High power view of the area in image A, showing        the progressively smaller clusters of tumor cells (dashed        arrows). (E) Higher power view of the keratin stained area shown        in D, highlighting the separated smaller tumor cell nodules.        Note the progressive decrease in tumor cell cluster size moving        from the top right corner toward the bottom left corner where        the tumor is present as individual single tumor cells (dashed        arrows). The solid arrow highlights the increased intervening        stroma with immune cells.    -   Column 3: (C) Immune cells (highlighted with solid arrow) seen        within the center of a tumor nodule (dashed arrows highlight the        tumor cells). (F) Low power view of a CD11b-stained section        highlighting the same area seen in image A. This shows the        increased density of immune cells (solid arrows) at the        periphery of the nodule and within the tumor nodule. Dashed        arrows highlight residual carcinoma cells that are not labeled        with the CD11b antibody.

Remarks: All three animals presented tumor growth in densely packedcollections of adenocarcinoma, however, two of the animals showed somefeatures compatible with tumor regression. This regression wascharacterized by the presence of progressive separation and loss oftumor cell clusters at the periphery of the tumor nodules withill-defined demarcated margins bordering the surrounding normal lungparenchyma. The lymphoid infiltrate in the areas showing tumor lossshowed an increase in lymphoid infiltrate in the stroma.

Inhaled NanoPac® Treatment Groups

Observations: FIG. 29 : Inhaled NanoPac® cases.

-   -   Top row: Low dose, 1×/week (LD1×) (case 3006). (A) H/E staining        showing tumor regression with in a nodule with prominent        separation and loss of tumor cells at the periphery (dashed        arrows show residual tumor and solid arrows show intervening        stroma with inflammation). (B) Keratin stain highlights the        residual carcinoma (dashed arrows) with a large intervening area        of tumor loss (solid arrows) composed of background stroma with        lymphocytes and macrophages. (C) CD11b immunostain highlights a        marked lymphohistiocytic immune cell infiltrate in the areas        where there is tumor cell dropout (solid arrows). Residual        unstained carcinoma is highlighted with dashed arrow.    -   Second row: Low dose, 2×/week (LD2×) (case 4009). (D) H/E        staining showed no residual viable adenocarcinoma. This case        contained scattered foci such as this that were composed of        collections of small lymphocytes and macrophages within        background stroma. No diagnostic viable tumor cells were seen in        these nodules, or elsewhere in the lung sections. (E) Keratin        stain in the same area as D, showing lack of staining, thus        adding immunohistochemical support for the interpretation of no        residual viable carcinoma and complete regression. (F) CD11b        stain shows that this focus has a mild-moderate immune cell        infiltrate.    -   Third row: High dose, 1×/week (HD1×) (case 5008). (G) H/E        staining showing tumor regression in a nodule with prominent        separation and loss of tumor cells at the periphery (dashed        arrows show residual tumor and solid arrows show intervening        stroma with inflammation). (H) Keratin stain highlights the        residual carcinoma (dashed arrows) and a large unstained area of        tumor loss (solid arrows) composed of background stroma with        lymphocytes and macrophages. (I) CD11b immunostain highlights a        marked immune cell infiltrate in the areas where there is tumor        cell dropout (solid arrow). Residual pockets of unstained        carcinoma are highlighted with dashed arrow.    -   Fourth row: High dose, 2×/week (HD2×) (case 6005). (J) H/E        staining showed numerous collections such as this one that        contains cells with eosinophilic and foamy cytoplasm (low        power). (K) Higher power of same area shows cells with spindled        nuclei (solid arrow) and rare possible duct-like structures or        regenerating small blood vessels (dashed arrow). (L) Masson        trichrome stain shows blue staining of stroma consistent with        early collagen fibrosis and organization.    -   Fifth row: High dose, 2×/week (HD2×) (case 6005 continued). (M)        Keratin stain shows labeling of focal single cells and duct-like        structures (dashed arrow). Intervening cells are negative for        keratin (solid arrow). (N) CD11b immunostain highlights an        immune cell infiltrate in the area where there is tumor cell        dropout (solid arrow). The magnification in this image matches        that in J.

Remarks: Of the 12 animals one animal presented no residualadenocarcinoma and was interpreted as a complete responder (versusnon-engraftment). One animal presented as difficult to classify as itcontained rare instances of tumor positive staining that were difficultto differentiate as tumor or as regenerative small blood vessels and/orregenerative/atrophic non-neoplastic lung parenchyma. As such, thissecond case also was interpreted as extensive and near-completeresponder. In these two cases, there were scattered foci of immune cellsin areas presumed to previously contain solid clusters ofadenocarcinoma. One case presented evidence of organization withdeposition of fibrous collagen noted by Masson's Trichrome staining. Allremaining 10 animals presented tumor nodules with varying degrees ofapparent tumor regression with 8 of the 10 animals presenting tumorregression in >50% of the tumor nodules. The inhaled NanoPac® grouppresented with lymphoid infiltrate that varied from well-definedorganized collections of densely packed mature lymphoid cells withwell-defined lymphoid follicles and germinal centers and interfollicularareas and paracortical zones. As well as smaller dense collections oflymphoid tissue at the periphery and focally within the center of thetumor nodules.

Observation of Tertiary Lymphoid Structures (TLSs)

Secondary lymphoid organs develop as part of a genetically preprogrammedprocess during embryogenesis and primarily serve to initiate adaptiveimmune response providing a location for interactions between rareantigen-specific naïve lymphocytes and antigen-presenting cells drainingfrom local tissue. Organogenesis of secondary lymphoid tissues can alsobe recapitulated in adulthood during de novo lymphoid neogenesis oftertiary lymphoid structures (TLS) and form in the inflamed tissueafflicted by various pathological conditions, including cancer.Organogenesis of mucosal-associated lymphoid tissue such asbronchial-associated lymphoid tissue is one such example. The term TLScan refer to structures of varying organization, from simple clusters oflymphocytes, to sophisticated, segregated structures highly reminiscentof secondary lymphoid organs. A notable difference between lymph nodesand TLS's is the that where lymph nodes are encapsulated, TLS'srepresent a congregation of immune and stromal cells confined within anorgan or tissue.

Observations: FIG. 30 : Lymphoid structures in treated and untreatedcases.

-   -   Top row: Inhaled NanoPac® case demonstrating tertiary lymphoid        structures (TLSs) with follicular hyperplasia. High dose,        2×/week (HD2×) (case 6007). (A) H/E stain showing two adjacent        TLSs (highlighted with solid arrows). In the lung these are        referred to as bronchial associated lymphoid tissue (BALT). Note        the organoid appearance of these TLSs in that they are composed        of well-circumscribed collections of dense lymphoid tissue with        distinct topology that includes lymphoid follicles with        prominent germinal centers, interfollicular areas and        paracortical zones. Dashed arrows highlight adjacent foci of        tumor with irregular peripheral borders consistent with tumor        regression. (B) Higher power image from area in A. The smaller        TLS contains a lymphoid follicle with a prominent germinal        center (paler area at tip of arrow). This process of germinal        center formation in lymphoid follicles is referred to as        follicular lymphoid hyperplasia and is indicative of lymphoid        tissue that is activated and is in the process of mounting an        immune response to various antigens including foreign material        and tumor debris. Germinal centers characteristically show        polarization with light and dark zones of lymphoid cells. In        this image, the pale zone of the germinal center is pointing        toward the adjacent tumor nodule. (C) Keratin stain showing the        adjacent carcinoma nodules that have irregular peripheral        borders. Solid arrow shows the TLS. This TLS appears smaller in        this section as this tissue section was from a deeper portion of        the paraffin embedded tissue compared to that in the H/E stained        section shown in A and B.    -   Second row: Comparison between control (D), IV Abraxane (E) and        NanoPac® (F) cases to illustrate the differences in the number        and density of smaller lymphoid collections associated with        tumor nodules in the different groups. These three images are        all at the same lower power magnification (4× objective). (D)        Control case (1003) shows densely packed adenocarcinoma (dashed        arrow) without any discrete lymphoid collections. (E) IV        Abraxane case (2009) showing nodules of adenocarcinoma (dashed        arrow) and only a single rare small lymphoid collection at the        lower right (solid arrow). (F) NanoPac® case, high dose 2×/week        (HD2×) showing adenocarcinoma nodules (dashed arrow) with        numerous associated small and medium sized collections of small        lymphoid cells. These are arranged at the periphery of the tumor        and also focally within the tumor (solid arrows).

Remarks: The inhaled NanoPac® groups showed increased numbers anddensity of TLSs (2 per low power field) compared to controls and the IVAbraxane group (1 per low power field), and more of these TLSs showedincreased size and activation with follicular lymphoid hyperplasiacontaining prominent germinal centers.

In summary, the sub-review of 17 animals presented some interestingpatterns with respect to tumor regression and immune response. Inparticular, all of the animals treated with NanoPac® showed at leastsome features compatible with tumor regression which includes twoanimals showing complete and/or near complete regression, while 8 of theremaining 10 animals in this group showed some features compatible withtumor regression in >50% of the tumor nodules. This was an increasedresponse compared to the control groups where there was no animal showeda response, and the IV Abraxane group where 2 of 3 animals showed tumorregression in 1-10% of the tumor nodules.

Evaluating the NanoPac® groups with each other, a higher dose andincreased frequency in dosage (2×/week versus 1×/week) were bothassociated with a greater effect on tumor response. The data supports animmune based association with tumor regression, the NanoPac® groups alsoshowed increased numbers, and density of TLSs (2 per low power field)compared to controls and the IV Abraxane group (1 per low power field),and more of these TLSs showed increased size and activation withfollicular lymphoid hyperplasia containing prominent germinal centers.There was also a greater density of immune cells at the periphery oftumor nodules and within tumor nodules in the NanoPac® groups.

Conclusions

One hundred twenty-seven (127) NIH-mu Nude Rats were x-irradiated toinduce immunosuppression on Day −1. On Day 0 animals were dosed withCalu3 tumor cells by intratracheal (IT) instillation. Animals underwenta growth period of three weeks. During the third week, animals wererandomized by body weight stratification into the groups. Starting Week4, animals in Group 2 received a once weekly dose of Abraxane® byintravenous (IV) dosing (5 mg/kg) on Days 22, 29 and 36. Animals inGroups 3 and 4 received once weekly (Monday) inhalation (INH) dose ofNanoPac® at low (0.5 mg/kg) and high (1.0 mg/kg) target doses,respectively. Animals in Groups 5 and 6 received a twice weekly (Mondayand Thursday) target inhalation dose of NanoPac® at low (0.50 mg/kg) andhigh (1.0 mg/kg) doses respectively. Animals in Group 1 were leftuntreated as a control of normal tumor cell growth. All animals werenecropsied during Week 8.

All animals survived to their designated necropsy timepoint. Clinicalobservations related to the model included skin rash, labored breathing.All groups gained weight at about the same rate through the course ofthe study.

The inhalation exposure average Paclitaxel aerosol concentration foronce weekly Low Dose and twice weekly Low Dose NanoPac® groups was270.51 μg/L and 263.56 μg/L, respectively. The inhalation exposureaverage Paclitaxel aerosol concentration for once weekly High Dose andtwice weekly High Dose NanoPac® groups was 244.82 μg/L and 245.76 μg/L,respectively.

Doses were based on average aerosol paclitaxel concentration, mostrecent average group bodyweight, assumed deposition fraction of 10% andexposure duration of 33 or 65 minutes. During four weeks of treatment,the average achieved rodent deposited dose for the once weekly Low DoseNanoPac® group and twice weekly Low Dose NanoPac® group were 0.655 mg/kgand 0.640 mg/kg (1.28 mg/kg/week), respectively. The average achievedrodent deposited dose for the once weekly High Dose NanoPac® group andtwice weekly High Dose NanoPac® group were 1.166 mg/kg and 1.176 mg/kg(2.352 mg/kg/week), respectively. For the group receiving IV injectionsof Abraxane®, the average dose on Day 22, 29 and 36 was 4.94, 4.64 and4.46 mg/kg respectively.

At scheduled necropsy, the majority of animals from each group had tannodules on the lungs and/or red or tan patchy discolorations of thelung. Other sporadic observations included an abdominal hernia in oneanimal and nodule on the pericardium of another animal. No otherabnormal gross observations were noted at necropsy.

In Abraxane treated animals, lung weights, lung to BW ratios and lung tobrain weight ratios were significantly lower compared to UntreatedControls. The once weekly NanoPac® High Dose group had similar weightsto the Abraxane group and significantly lower lung weights and lung tobrain ratios compared to Untreated Controls.

Compared to the positive control Grp. 1 and the Abraxane treatedcomparative Grp. 2, there was a therapeutic effect as measured by lowerlung/brain weight ratio and lower overall lung tumor burden withoutapparent adverse events. Histological analysis of lung tumor burdentreated with inhaled NanoPac® showed a decrease in tumor mass, adecrease in primitive tumor cell population, and an increase in tumorregression. Extensive mononuclear cell infiltration was observed in thelungs of animals receiving NanoPac® through inhalation. As the modelused is T cell deficient, it is likely that the cells are B cells or NKcells. It is hypothesized that the localized, likely higherconcentration exposure of the tumor to NanoPac® affected the tumorsleading to an alteration in the environment to draw the mononuclearcellular infiltrate into the lung.

Example 14—Human Bladder Cancer (UM-UC-3) Mouse Xenograft Study

A study was conducted to evaluate the effect of 1, 2, and 3 weeklyintratumoral injection (IT) administrations (administration cycles) ofNANODOCE® (nanoparticle docetaxel as disclosed herein, approximately 99%docetaxel with a mean particle size (number) of 1.078 microns, a SSA of37.2 m²/g, and a bulk density (not tapped) of 0.0723 g/cm³ used in thisexample) suspension on growth of subcutaneous (SC) UM-UC-3 bladdercancer cell line (ATCC-CRL-1749) tumors in immunocompromised(Hsd:Athymic Nude-Foxn1nu nude) mice. Intratumoral injectionadministration of a vehicle and intravenous (IV) administration ofdocetaxel solution were also incorporated into the study as controlgroups.

Tumors were implanted with 1×10⁷ cells (100 μL volume) into right flank(PBS 1:1 with matrigel: BD356234). Tumor volume was determined withcalipers. Formula: V=(r length*r width*r height)*π*4/3. Animals wereweighed 2×/week. Tumor volumes were determined every 3 to 4 daysfollowing tumor implant (total of ˜20 measurements) and on day ofeuthanasia. Photo images of tumors were obtained at 2, 3 and 4 weekspost implantation and on day of euthanasia. Animals were euthanized oncethe tumor reached a size of 3,000 mm³ or up to the point of significanttumor ulceration. At the time of euthanasia, tumors were isolated andhalved. One half of the tumor was flash frozen in LN2 stored at −80° C.and will subsequently be analyzed. The second half of the tumor wasfixed in formalin. Two H&E stained slides/tumor were prepared (up to 4tumor/group were processed).

At day 18 after tumor implant, when average tumor size was between50-325 mm³, animals were sorted into five groups with equal averagetumor sizes and were treated as shown in Table 25 below.

TABLE 25 Main Study Design Weekly Admin Group Name Treatment Cycles n AVehicle IT Vehicle (IT) 3 10 3 cycles 63 μl/tumor B Docetaxel IVDocetaxel 3 9 3 cycles Solution 30 mg/kg (IV) Docetaxel = 3 mg/mL CNanoDoce ® IT NanoDoce ® 1 10 1 cycle Suspension 100 mg/kg (IT)NanoDoce ® = 40 mg/mL; 63 μl/tumor (2.5 mg NanoDoce ®) D NanoDoce ® ITNanoDoce ® 2 9 2 cycles Suspension 100 mg/kg (IT) NanoDoce ® = 40 mg/mL;63 μl/tumor (2.5 mg NanoDoce ®) E NanoDoce ® IT NanoDoce ® 3 9 3 cyclesSuspension 100 mg/kg (IT) NanoDoce ® = 40 mg/mL; 63 μl/tumor (2.5 mgNanoDoce ®)

For IT administration (Vehicle/NANODOCE®), injections (using 27 G, ½″needle) were administered at three sites within the tumor (totalcalculated injection volume based on 40 mg/mL NANODOCE® stock and 25 gmouse=63 μL; split evenly across the three injection sites) to maximizedistribution of the test formulation throughout the tumor. The secondtreatments (2^(nd) cycle) occurred 7 days following first treatment(1^(st) cycle) and third treatments (3^(rd) cycle) occurred 14 daysfollowing the first treatment. The docetaxel solution IV wasadministered via the tail vein.

The test formulations were prepared as follows:

Vehicle (Control): Diluted 1 ml of the 1% Polysorbate 80/8% Ethanol innormal saline (0.9% Sodium Chloride for Injection) reconstitutionsolution with 1.5 mL of normal saline (0.9% Sodium Chloride forInjection, USP). The final concentration of polysorbate 80 was 0.4% andthe final concentration of ethanol was 3.2% in the Vehicle.NANODOCE® Suspension: Added 1 ml of the 1% Polysorbate 80/8% Ethanol innormal saline (0.9% Sodium Chloride for Injection) reconstitutionsolution into the vial of NANODOCE® particles powder (100 mg/60 ccvial). The mean particle size (number) of the NANODOCE® particles powderwas 1.0 micron. Vigorously hand shook the vial with inversions for 1minute. Immediately after shaking, added 1.5 ml of normal salinesolution (0.9% Sodium Chloride for Injection USP) to the vial and handshook the vial for another 1 minute to make a 40 mg/mL suspension.Allowed the suspension to sit undisturbed for at least 5 minutes toreduce entrapped air and foam.Docetaxel Solution: Prepared a 20 mg/mL docetaxel stock solution in 50%Ethanol/50% Polysorbate 80. Added normal saline solution (0.9% SodiumChloride for Injection) to stock solution to make a final, 3 mg/mLdocetaxel solution. Vortexed to mix.

Results:

Tumor volumes were determined 2×/week for the duration of the study (61days). The results of the study are shown in FIG. 31 , FIG. 32 , FIG. 33, FIG. 34 , FIG. 35 , FIG. 36 , FIG. 37 , FIG. 38 , FIG. 39 & FIG. 40 .As seen in FIG. 31 , tumor volumes decreased and tumors were effectivelyeliminated for dosages of NanoDoce® IT 2 cycles and NanoDoce® IT 3cycles. Tumor volumes decreased initially for dosages of NanoDoce® IT 1cycle and Docetaxel IV 3 cycles, but subsequently increased. Theseobservations are also reflected in FIG. 32 , FIG. 33 , FIG. 34 , FIG. 35, FIG. 36 , FIG. 39 & FIG. 40 .

The scatter plot in FIG. 37 shows tumor volumes per animal on Day 1 oftreatment vs. end of study (day of sacrifice). As can be seen in FIG. 37, the volume of the tumor in a given animal at the end of study was notdependent upon the initial size of the tumor of the same animal for theanimals treated with NanoDoce® IT 2 cycles and NanoDoce® IT 3 cycles, asessentially all the tumors were effectively eliminated. However, foranimals treated with Docetaxel IV 3 cycles, the volume of the tumor atthe end of the study was generally dependent upon the initial tumorvolume for a given animal, i.e., the larger the initial tumor volume,the larger the tumor volume at the end of the study. The treatment withDocetaxel IV 3 cycles was somewhat effective at treating small tumors,but not very effective in treating large tumors. Administering NanoDoce®IT (intratumorally) for 2 cycles or 3 cycles effectively treated thetumors regardless of the initial tumor size.

As can be seen in FIG. 38 , the initial animal weight loss for animalstreated with Docetaxel IV 3 cycles was generally greater than that ofanimals treated with NanoDoce® IT 1 cycle, NanoDoce® IT 2 cycles, andNanoDoce® IT 3 cycles. Weights eventually recovered to some degree inall treatments. This may suggest that the side effect of initialappetite loss is greater with Docetaxel IV administration than withNanoDoce® IT administrations. It was also observed that animals treatedwith Docetaxel IV 3 cycles had greater signs of peripheral neuropathythan did those treated with NanoDoce® IT 3 cycles, and no signs ofperipheral neuropathy were observed in those treated with NanoDoce® IT 1cycle or 2 cycles.

On the day of death or euthanasia, tumor tissues samples were collectedand frozen in LN2 for docetaxel analysis, histology, andimmunohistochemistry (IHC) observations. In the IV docetaxel controlgroup, only 1 tumor (of 7 measured) had docetaxel levels above the limitof quantitation of the assay (1 ng/g). Measurable levels of docetaxelwere found in all tumors from the IT NanoDoce® groups with the NanoDoce®3 cycle group tending to have the highest concentrations of docetaxelremaining in the tumors (see FIG. 41). Photomicrographs of histologyslides, H&E stain, are shown in FIGS. 42 to 52 . Photomicrographs of IHCslides stained with F4/80 antibody stain are shown in FIG. 53 , FIG. 54, and FIG. 55 .

Histological Overview of Photomicrographs in FIGS. 42 to 52 GeneralObservations:

Control: Extensive levels of viable tumor with proliferating cells andlittle to no mononuclear immune cell infiltration, occasionalmacrophages noted.

Docetaxel Solution: many viable appearing tumor masses with somemacrophage and occasional lymphocytic response along with some tumornecrosis.

NanoDoce® 2 cycles: Some remaining isolated tumor cells, small area ofskin injury, scar/fibrosis seen, immune cell infiltrate includingmacrophages and mononuclear cells.

NanoDoce® 3 cycles: Some remaining isolated tumor cells, small area ofskin injury, scar/fibrosis seen, immune cell infiltrate includingmacrophages and mononuclear cells

Extensive mononuclear cell infiltration was observed at the site oftumor implantation in the subcutaneous space in animals receivingintratumoral injection of NanoDoce®. With increased numbers of cycles,there is increased tumor response, but there is some skin injury,perhaps due to the small space and shallow area for injection on theflank of a nude mouse (e.g., tumor right up against skin that is tightlydrawn over the tumor). As the model used is T cell deficient, it islikely that the lymphocytic cells are B cells or NK cells. B cells areresponsible for the production of cytotoxicity (the antibodies bind tocells expressing Fc Receptors and enhance the killing ability of thesecells. NK cells are innate lymphoid cells that are crucial in thekilling of tumor cells. In patients with tumors, NK cell activity isreduced allowing for the growth of the tumor. Along with T cells, NKcells are the target of some check point inhibitors to increase theiractivity. In all histological samples provided, macrophages were presentin the tumor, but the number did not appear to significantly increase.

By the use of a wide array of surface receptors capable of deliveringeither triggering or inhibitory signals, NK cells can monitor cellswithin their environment to ascertain if the cell is abnormal (tumor orvirally infected) and should be eliminated through cytotoxicity. Thecytotoxicity and chemotaxis of NK cells can be modified by manypathological processes including tumor cells and their byproducts. Inresponse to certain signals their functions are enhanced or potentiated.In response to several Pathogen Associated Molecular Patterns (PAMPs) byusing different Toll Like Receptors (TLR); NK cells can increasecytokine production and/or cytolytic activity. Cytokines, includingIL-2, IL-15, IL-12, IL-18, and IFNs α/β can also modify the activity ofNK cells. NK cells are not simple cells that are only cytolyticeffectors capable of killing different tumor cell targets; rather, theyrepresent a heterogeneous population which can finely tune theiractivity in variable environmental contexts.

The tumor burden is significantly reduced in the site of xenograftinjection in the animals treated with NanoDoce® and the intratumoralinjection is more effective than intravenous docetaxel. Therefore, thelocalized administration of docetaxel in the form of NanoDoce® providesadditional potency. This is likely due to both the longer exposure tothe chemotherapy over time and the vigorous cellular infiltration to thesite of the tumor. This latter response appeared to be dependent on thedose density (actual dose and dose frequency). Anatomically, macrophagesare present at high numbers at the margins of tumors with decreasingfrequency throughout the stroma moving deeper within the tumor.

Immunohistochemistry Overview of FIG. 53, FIG. 54, and FIG. 55

FIG. 53 : Vast sheet of viable tumor cells and no mononuclear immunecells (no brown staining).

FIG. 54 : Very little tumor cell destruction and few scatteredmononuclear immune cells among vast number of viable tumor cells.

FIG. 55 : Virtually no tumor cells left and vast numbers of mononuclearimmune cells organized into distinct patterns (likely mostlymacrophages).

Example 15—Drug Efficacy Study in Rat Xenograft Model of Human RenalCell Adenocarcinoma

A non-GLP study was conducted to determine the drug efficacy of NanoPac®(nanoparticle paclitaxel) suspension and NanoDoce® (nanoparticledocetaxel) suspension administered by intratumoral injections in a ratxenograft model of human renal cell adenocarcinoma.

Objectives

The objective of this study was to investigate the potential efficacy ofNanoPac® (nanoparticle paclitaxel) and NanoDoce® (nanoparticledocetaxel), administered by intratumoral (IT) injections over a periodof time in the Sprague-Dawley Rag2; Il2rg null (SRG®) rat xenograftmodel of human renal cell adenocarcinoma (786-0 cell line)(ATCC®CRL-1932™). Five to seven weeks old SRG rats were inoculated with5 million 786-0 cells in Cultrex® subcutaneously to develop tumorxenograft. Once the tumor volume reached 150-300 mm³, the rats wereenrolled on a rolling basis into treatment groups consisting of the testarticles (administered IT); positive controls (paclitaxel and docetaxel;administered intravenous (IV)) and a vehicle control (administered IT),then monitored for the tumor growth or regression.

Cell Culture

Cell lines: 786-0 cell line (ATCC®CRL-1932™). Cells were stored inliquid nitrogen. Upon thawing, cells were cultured at 37° C., 5% CO2.After cells were prepared for transplant, they were maintained on iceuntil injection.

Cell culture conditions: Cells were cultured in RPMI 1640 (Gibco#410491-01) +10% FBS on tissue-culture treated flasks at 37° C., 5% CO2.Cells were expanded for 2-3 weeks prior to inoculation. Cell thawing,culturing and passaging was carried by ATCC(www.atcc.org/Products/All/CRL-1932.aspx)

Cell Inoculation: 5×10⁶ cells per rat; subcutaneous left hind flank,dorsal side.

Inoculation vehicle: 50% Cultrex BME type 3 (Trevigen #3632-001-02; atype of basement membrane matrix like Matrigel® formulated for in vivotumor growth) 50% Media in a total volume of 0.5 ml. Cell suspensionmixed 1:1 with 10 mg/mL Cultrex for a final concentration of 5 mg/mLCultrex. Final inoculation volume is 500 ul.

Preparation of Test Articles (NanoPac® and NanoDoce® Suspension)

Drug: NanoPac® (nanoparticle paclitaxel powder, approximately 98%paclitaxel with a mean particle size (number) of 0.878 microns, a SSA of26.7 m²/g, and a bulk density (not tapped) of 0.0763 g/cm³ used in thisexample) 306 mg in a 60 mL vial; and NanoDoce® (nanoparticle docetaxelpowder, approximately 99% docetaxel with a mean particle size (number)of 1.078 microns, a SSA of 37.2 m²/g, and a bulk density (not tapped) of0.0723 g/cm³ used in this example) 100 mg in a 60 mL vial.

For NanoPac® Suspension (Final Concentration: 20 mg/mL NanoPac® and0.32% Polysorbate 80 in Normal Saline Solution—Final Volume: 15.3 mL PerVial):

Using a sterile syringe with a sterile 18-gauge needle or larger, added5.0 mL of a sterile 1% polysorbate 80 reconstitution solution into the60 ml NanoPac® powder vial (containing 306 mg NanoPac® powder).

Vigorously hand shook the vial with inversions to make sure all theparticles adhering to the interior of the vial and stopper are wetted.

Continued shaking for 1 minute and examined the suspension for any largeclumps of particles.

Immediately after shaking, used a sterile syringe with a sterile18-gauge needle or larger to add 10.3 mL of a normal saline solution(0.9% sodium chloride solution for injection) to the vial and hand shookthe vial for another 1 minute. Periodically examined the suspension forany large visible clumps. If present, continued hand mixing until thesuspension was properly dispersed.

After mixing, allowed the suspension to sit undisturbed for at least 5minutes to reduce entrapped air and foam.

For NanoDoce® Suspension (Final Concentration: 20 mg/mL NanoDoce®, 0.20%Polysorbate 80, and 1.6% Ethanol in Normal Saline Solution—Final Volume:5 mL Per Vial):

Using a sterile syringe with a sterile 18-gauge needle or larger, added1 mL of a sterile 1% polysorbate 80/8% ethanol reconstitution solutioninto the 60 ml NanoDoce® powder vial (containing 100 mg NanoDoce®powder).

Vigorously hand shook the vial with inversions to make sure all theparticles adhering to the interior of the vial and stopper are wetted.

Continued shaking for 1 minute and examined the suspension for any largeclumps of particles.

Immediately after shaking, used a sterile syringe with a sterile18-gauge needle or larger to add 4 mL of normal saline solution (0.9%sodium chloride for injection) to the vial and hand shook the vial foranother 1 minute. Periodically examined the suspension for any largevisible clumps. If present, continued hand mixing until the suspensionwas properly dispersed.

After mixing, allowed the suspension to sit undisturbed for at least 5minutes to reduce entrapped air and foam.

Intratumoral (IT) Vehicle (Final concentration: 0.2% Polysorbate 80 and1.6% ethanol in normal saline solution): Each 1 mL of a 1%Polysorbate/8% ethanol reconstitution solution was diluted with 4 mL ofnormal saline solution (0.9% sodium chloride solution for injection).

Preparation of Positive Controls Formulation

Drug: Docetaxel: CAS 114977-28-5, and Paclitaxel: CAS 33069-62-4. Purity>97%

For Docetaxel Solution: Made a 20 mg/mL solution of docetaxel in 50%ethanol:50% Polysorbate 80. Vortexed to mix. Added normal salinesolution to dilute to a 3 mg/mL solution of docetaxel.

For Paclitaxel Solution: Used bulk paclitaxel to make 6 mg/mLformulation in 50%

ethanol: 50% Cremophor EL. Vortexed as needed to mix. Added normalsaline solution to dilute to a 3 mg/mL solution of paclitaxel. Vortex tomix.

Test System

Species/Strain: Rat (Rattus norvegicus)/Rag2^(−i−); Il2rg^(−i−) onSprague Dawley background (SRG®).

Number of Animals/Approximate Age and Weight: Sixty healthy rats (30males and 30 females) were assigned for this study and used forxenograft development. At least 54 tumor-bearing animals in total wereenrolled for treatment (27 males and 27 females) as they reached therequired tumor volume. These animals were inoculated with 786-0 cells instaggered batches on the same day, pending animal availability. Animalswere approximately 5-7 weeks of age at the onset of the study.Approximate weight was 150-275 g. Animals were enrolled in the treatmentgroups on a rolling basis when the tumor size reached 150-300 mm³.

Organization of Treatment Groups, Dosage Levels and Treatment Regimen

Table 26 below presents the study group arrangement.

TABLE 26 Dose route, Dosage Dose Dose Dose level concentration volumeNumber Group Treatment Schedule (mg/kg/day) (mg/ml) (ml/kg) ** of rats*1 Vehicle IT, QWX3 0 N/A 1 6 2 Paclitaxel IV, QWX3 5 3 1.67 6 3NanoPac ® IT, QWX1 20 20 1 6 4 NanoPac ® IT, QWX2 20 20 1 6 5 NanoPac ®IT, QWX3 20 20 1 6 6 Docetaxel IV, QWX3 2.5-5 3 0.835-1.67 6 7NanoDoce ® IT, QWX1 20 20 1 6 8 NanoDoce ® IT, QWX2 20 20 1 6 9NanoDoce ® IT, QWX3 20 20 1 6 *3 males and 3 females were allocated pergroup.

Treatment Regimen:

All rats that developed tumors that reached 150-300 mm³ in volume wereenrolled in treatment. All treatment will commence after 7 days postinoculation when tumors are >150 mm³.

Groups 3, 4 and 5 rats received NanoPac® and groups 7, 8 and 9 ratsreceived NanoDoce®. Groups 3 and 7 received IT injections only onstaging day (first day of treatment), groups 4 and 8 received ITinjections on staging day and 7 days post initiation of treatment, andgroups 5 and 9 received IT injections on staging day, 7 and 14 days postinitiation of treatment. Positive control test articles (paclitaxel anddocetaxel) were administered intravenously by tail vein injection onstaging day, 7 and 14 days post-initiation of treatment to Groups 2(paclitaxel) and 6 (docetaxel) rats. The vehicle control wasadministered by IT injection on staging day, 7 and 14 dayspost-initiation of treatment to group 1 animals.

Methods of Administration:

The test articles and the vehicle were administered by IT injections orIV injections depending on the dosing group, with sterile needles andsyringes. All IV injections were administered using a 27 G needle.

IT injections were distributed across the tumor in 6 injections when thetumor was intact and 3 injections in case of an ulcerating tumor. Thenumber of IT injections per tumor during all dosing days were recordedin the raw data.

The dose volume was 1 mL/kg for the vehicle, NanoPac® and NanoDoce® and1.67 mL/kg for paclitaxel and docetaxel. For group 6, the dosage ofDocetaxel was changed to 2.5 mL/kg and the dose volume was decreased to0.835 mL/kg. At the time of dose administration, NanoPac® and NanoDoce®vials were inverted gently 5-10 times immediately prior to dose removalto ensure uniformity of the suspension.

Using a sterile syringe with a sterile 18-gauge* needle or larger bore,inverted the vial and inserted the needle into the septum of theinverted vial. Withdrew just over the amount of suspension needed,removed the needle from the vial and adjusted to the desired volume.Recapped the needle. *Note: for IT injections, a 27 G needle was usedfor administration.

IT injections were administered across the tumor in a Z pattern (acrosstop, diagonal through, then across bottom) and reversed each followingdosing occasion(s). The injections were administered with the needlebevel facing down to minimize leakage of the TA post injection. The skinwas also pulled slightly back prior to needle entry and during theinjection to also minimize TA leakage post injection. Efforts were madeto ensure IT injection administration patterns are consistent across allanimals and dosing days.

NanoPac® was used within 1 hour and NanoDoce® within 24 hours ofreconstitution. The positive controls and docetaxel were maintained atroom temperature and used within 8 hours of formulation while paclitaxelwas kept in warm water after reconstitution and used within 20 minutes.

Observations:

Individual Body Weights: Three times weekly (M, W, F) starting at thetime of inoculation.

Individual Tumor Volumes: Animals were palpated daily starting the dayafter tumor inoculation. Tumor length and width were measured withdigital calipers and recorded starting when tumor volume reached 50 mm³,at which point tumors were measured three times weekly (M, W, F) and atthe time of necropsy. Tumor volume (mm³) was calculated as =(L×W²)/2where ‘L’ is the largest diameter.

Tumor Imaging: Photographs of all tumors were taken on staging day priorto commencement of treatment and 7, 14, 21, 28, 35, and 42 days postinitiation of treatment. Additional tumor photographs were also taken atthe time of necropsy of all rats including animals reaching end-pointbefore study termination. All photographs will be taken with the animalin an anterior-posterior orientation with a photo-tag that states theanimal I.D., study day and date.

Blood Sample Collection for Analysis: 200-250 ul of blood was collectedfrom the tail or jugular vein of all treated animals at studytermination, i.e. 50 days post initiation of treatment.

Scheduled Necropsy: All animals were scheduled for necropsy 50 days postthe initiation of the treatment. Day 0 was day of tumor inoculation.

Anatomic Pathology:

Macroscopic Examination: A necropsy was conducted on all animals dyingspontaneously, euthanized in extremis or at the scheduled necropsy after50 days post initiation of treatment. Animals euthanized in extremis orat study termination were euthanized by CO2 inhalation. Necropsyincluded examination of the external surface, all orifices and thethoracic, abdominal and pelvic cavities, including viscera. At the timeof necropsy, a final body weight and body condition score was collected.

Tissue Collection: Primary Tumor (Inoculation site)—A final tumormeasurement was taken prior to excision. Tumors were weighed afterexcision. Approximately ½ of each tumor (based on visual assessment) wasflash frozen in 2-methylbutane on dry ice, the tumor piece was weighedwhen possible before it is flash frozen. The remaining was fixed in 10%neutral buffered formalin. Tumors were also collected from animals notreaching enrollment volume. Secondary Tumors—Any organ with visibletumors were collected and fixed in 10% neutral buffered formalin.Formalin fixed tissues were stored at room temperature. Frozen tissueswere stored at −80° C. All tissue was stored for up to 3 months.Pictures of all tumors; primary and secondary if present, were taken.

Microscopic Examination: Tissues fixed with 10% NBF were embedded inparaffin. Each tumor was cut into 2-3 pieces and embedded and sectionedtogether. For each tumor, 3 slides were prepared and stained with H&E.Photomicrographs of preliminary histology slides from female rats forNon-Treated, Vehicle Control (IT) 3 cycles, Docetaxel (IV) 3 cycles, andNanoDoce® (IT) 3 cycles are shown in FIG. 56 , FIG. 57 , FIG. 58 , andFIG. 59 , respectively.

Additional H&E and Immunohistochemical (IHC) evaluations were conductedon formalin-fixed tissue from animals from the Docetaxel group and areshown in FIGS. 60 and 61 .

Histology Overview of Photomicrographs in FIG. 57, FIG. 58, and FIG. 59.

Vehicle Control (IT) 3 cycles, FIG. 57 : The photomicrograph shows“packets” of multi-/bi-nucleate tumor cells surrounded by extracellularmatrix.

Docetaxel (IV) 3 cycles, FIG. 58 : The photomicrograph showsmorphologically similar “packets” of viable renal cell carcinoma seen inthe vehicle control: no difference.

NanoDoce® (IT) 3 cycles, FIG. 59 : The photomicrograph shows a band ofmononuclear cells representing a robust immune response to the tumorcells. Some dead tumor or dying tumor is present characterized ascellular “ghosts” (shown left of the mononuclear immune cell band). Tothe right of the mononuclear cell band are “ghosts” covered by a“sprinkling” of mononuclear immune cells.

Additional H&E and Immunohistochemical (IHC) evaluation of the DocetaxelGroups

Observations: FIG. 60 Control Cases. Top row: H&E stained sections.Bottom row: Immunohistochemical staining.

-   -   Column 1: (A) Renal cell carcinoma composed of closely apposed        cohesive clusters and cords of large tumor cells with        pleomorphic nuclei and visible nucleoli. Note the minimal        intervening stroma that contains scattered small blood vessels        (dashed arrow bottom left). Note multinucleated carcinoma cell        at top of image (solid arrow). (D) Keratin (AE1/AE3) immunostain        performed on the same tumor shown in A. This demonstrates        sensitive and specific labeling of carcinoma cells with        pancytokeratin (solid arrow).    -   Column 2: (B) Focal area of tumor cell necrosis composed of        uniformly homogenous amorphous eosinophilic material (dashed        arrow). Note the discrete nature of this focus with sharp        demarcation from the surrounding viable carcinoma cells (solid        arrows). This was the typical appearance of necrosis in the        control groups. This was present in central areas of the tumor        and occupied less than 5% of the tumor area. (E) CD68 stain        (macrophage marker) highlighting the same area shown in image B.        This shows limited numbers of macrophages in the viable        carcinoma (solid arrow) and markedly increased macrophages in        the focus of necrosis (dashed arrow). The latter finding        illustrates the characteristic macrophage function of necrotic        debris phagocytosis.    -   Column 3: (C) Limited numbers of small lymphocytes in the        peritumoral surrounding non-neoplastic stroma (dashed arrow).        Note carcinoma in top right corner (solid arrow). In the control        groups, there were typically very few lymphocytes within the        tumor itself and the peritumoral soft tissue generally contained        a mild lymphoid infiltrate. (F) Corresponding focus to that seen        in C, stained with CD11b, showing positive staining in lymphoid        cells (dashed arrow). Note carcinoma in top right corner (solid        arrow).

Remarks: The two control cases demonstrated similar findings at themorphologic and immunohistochemical level. Both contained a dense noduleof invasive carcinoma that was sharply demarcated from the surroundingnormal stromal tissue without a discrete well-formed fibrous capsule.Within the tumor nodule, the carcinoma cells were arranged into smallorganized clusters and cords of tumor cells and these were closelypacked together with a minimal amount of intervening stoma thatcontained compressed small blood vessels (FIG. 60 —Slide A). The tumorcells were large with pleomorphic nuclei that had vesicular chromatinand prominent eosinophilic nucleoli that were clearly visible at 100×magnification (10× eyepiece and 10× objective lens). The nuclei includedrounded and spindled forms and scattered multinucleated giant tumorcells were present (FIG. 60 —Slide A). The tumor cells had an abundantamount of lightly eosinophilic and clear cytoplasm and they showedincreased mitotic activity (13 mitoses per 10 high power fields [400×hpf]). Scattered discrete foci of coagulative tumor cell necrosis werepresent and these were more frequent within central portions of thetumor nodule (FIG. 60 —Slide B). The foci of necrosis consisted ofhomogenous eosinophilic necrotic debris that was relatively welldemarcated from surrounding viable tumor cells. The foci of necrosisoccupied less than 5% of the tumor cell area. Immunohistochemicalstaining for pancytokeratin (AE1/AE3) highlighted the tumor cells anddisplayed cytoplasmic and membranous localization (FIG. 60 —Slide D).The keratin labeling was strong, sensitive and specific, with sharpdemarcation between positively stained tumor cells and negativelystained surrounding non-carcinomatous tissue. There was no overt tumorregression noted in either of the two control group animals. There wasno significant lymphoid infiltrate within the tumor and in particular,there were no discrete small lymphoid collections or tertiary lymphoidstructures (TLS) in the tumor tissue or in the surroundingnon-neoplastic stromal tissue. The surrounding stroma contained a patchymild lymphoid infiltrate composed of scattered small lymphocytes thatwere mainly arranged as single cells (FIG. 60 —Slide C).Immunohistochemical staining for CD11b (marker of NK cells andhistiocytes) highlighted the mild immune cell infiltrate in thesurrounding non-neoplastic stroma (FIG. 60 .—Slide F); however, therewas no significant lymphoid component within the tumor.Immunohistochemical staining for CD68 (marker of macrophages)highlighted a mild macrophage infiltrate within and around the tumorwith increased density of staining within the foci of tumor necrosis,consistent with increased macrophages in areas containing increasedcellular debris (FIG. 60 .—Slide E).

Observations: FIG. 61 . Intratumoral NanoDoce® cases (representativeimages from all groups included: 1 cycle, 2 cycles and 3 cycles).

-   -   Top row: One cycle NanoDoce® (1×) (case 750-258). (A) Low power        H&E staining showing extensive geographic tumor cell necrosis        consisting of homogeneous eosinophilic staining of non-viable        necrotic material (solid arrows). Note the central vertical line        of demarcation consisting of a dense band of necrotic debris and        admixed immunecells (dashed arrows) (B) High power view of line        of demarcation. Note the dense collection of immune cells and        admixed debris (dashed arrows at right). On the left of the        image there is extensive necrotic material with no viable tumor        cells (solid arrows) (C) High power view of the central portion        of necrosis corresponding to the left half of image A. Solid        arrows point to ghost outlines of necrotic tumor cells. The        dashed arrow highlights a degenerating small blood vessel.    -   Second row: One cycle NanoDoce® (1×) (case 750-258). Each image        corresponds to the H&E image above it. (D) CD11 b immunostain of        area seen in image A. This highlights the dense collection of        immune cells in the central band of necrotic debris and immune        cell infiltrate This stain also highlights immune cell response        in the surrounding tissue at right but there is a lesser degree        of inflammation in the central area of tumor necrosis at        left. (E) Keratin stain showing the same area as seen in B. This        shows complete absence of staining, thus adding strong        immunohistochemical support for the interpretation of no        residual viable carcinoma in this area. (F) Keratin stain from        central area of necrosis shown in image C. This shows keratin        labeling of degenerating keratin filaments in the necrotic ghost        cell outlines (solid arrows) which supports the hypothesis that        viable carcinoma subsequently underwent complete regression and        necrosis; however, there are no residual viable tumor cells        present in this area (lack of viable nuclei best appreciated in        H&E image above).    -   Third row: Two cycles NanoDoce® (2×) (case 748-827). (G) H&E        staining showing a 0.9 mm residual focus of viable carcinoma        (solid arrow) surrounded by extensive necrotic material (dashed        arrows). (H) Same focus of carcinoma at higher power showing        viable tumor cells with retained nuclei (solid arrow). Note the        progressive loss of viable tumor cells toward the lower left        corner (dashed arrow) (I) Higher power of same focus        illustrating the leading edge of the viable tumor (solid arrow)        and the adjacent zone of tumor cell death. Here, remnants of        tumor cells in progressive stages of cell death are evidenced by        progressive loss of nuclei and loss of discrete cytoplasmic        membrane outlines (dashed arrows).    -   Fourth row: Two cycles NanoDoce® (2×) (case 748-827). Each image        corresponds to the H&E image above it. (J) Low power view of        keratin stain with the focus of residual viable carcinoma in top        left of image (solid arrow). Surrounding this focus is a lack of        keratin staining (dashed arrows), exhibiting the extent of the        necrotic material. (K) Higher power view of the same        keratin-stained tumor showing viable nucleated carcinoma cells        that label strongly with keratin antibody (solid arrow) and        surrounding necrotic tissue that is negative for keratin        staining (dashed arrow). (L) Keratin stain of the same area,        illustrating progressive transition from viable nucleated        keratin-positive carcinoma cells in top right (solid arrows) to        tumor cells in varying stages of necrosis towards bottom left        corner (dashed arrows). The latter include a nuclear ghost        outlines of tumor cells that show keratin labeling of residual        degenerating tumor cell keratin intermediate filaments; however,        these cells are non-viable. This supports the impression that        the necrotic material surrounding the viable carcinoma        previously contained viable carcinoma that subsequently died        following therapy.    -   Fifth row: Three cycles NanoDoce® (3×) (case 748-822). (M) Low        power H&E stained section showing dense amorphous necrosis on        the right (solid arrow) that is demarcated from surrounding zone        of degenerating fibrofatty tissue on the left by a band of        necrotic debris and admixed immune cells (dashed arrow). (N)        High power view of necrotic area showing no viable nucleated        carcinoma cells (solid arrow). (O) Keratin stained section of        same area in image N, showing complete absence of staining        (solid arrow), thus further supporting an absence of residual        carcinoma in this area following therapy.

Remarks:

Intratumoral NanoDoce® 1 Cycle:

Two of the three animals in this group contained residual viableinvasive carcinoma. When measured on the H/E stained slide this wassignificantly smaller in size (up to 5 mm in maximum cross-sectionaldimension on the slide) compared to the control, IT vehicle and IVdocetaxel groups (range of 9-15 mm with most of these being closer to 15mm in maximum cross-sectional dimension on the slide). Where present,the morphology of the tumor cells in these two IT NanoDoce® cases wasessentially identical to that seen in the above-mentioned non-ITdocetaxel groups. Both IT NanoDoce® cases did not have sufficient anon-viable tumor or non-neoplastic stroma for evaluation of surroundingnecrosis although one of these did have a focal peripheral rim ofnecrosis that occupied <5% of the submitted tissue. Similar to thecontrol groups, there was only a mild immune cell infiltrate associatedwith these tumors in the surrounding non-neoplastic stromal tissue(where evaluable) and this was highlighted by a CD11b immunostain. Notertiary lymphoid structures (TLS) were noted in the sections examined.The third animal in this group showed no viable residual invasivecarcinoma and extensive geographic tumor cell coagulative necrosis.Extensive areas of necrosis blended with surrounding stromal fibrous,fatty and skeletal muscle tissue. In areas there was a line ofdemarcation between the amorphous necrosis and adjacent degeneratingfibrofatty tissue which this consisted of a dense band of necroticdebris and admixed immune cells (FIG. 61 —Slide A and B). No diagnosticviable tumor cells were noted on H/E stained section examination (FIG.61 —Slide B); however, in the central portion of the amorphous necroticmaterial there was a small area where ghost outlines of nuclear necrotictumor cells were noted (FIG. 61 —Slide C). This was also highlighted onthe keratin-stained section where the keratin antibody labeleddegenerating keratin filaments in the necrotic cell outlines (FIG. 61—Slide F). In addition, very focally within the degenerating andnecrotic fibrofatty tissue, the keratin stained section of this animalshowed focal cytoplasmic labeling that appeared consistent withhistiocytic engulfment of degenerating keratin intermediate filaments.Of importance, the keratin stain did not show discrete cytoplasmicmembrane labeling of viable carcinoma cells and it did not show anycohesive collections of keratin-labeled diagnostic viable tumor cells.In some areas there were abundant granular blue material that coalescedinto small homogenous structures focally that were suggestive ofdystrophic calcification. This granular material was difficult todefinitively identify, and the differential diagnosis included granularnecrotic debris and calcium, degenerating skeletal muscle fibers andnanoparticles. Immunohistochemical staining for CD11b in the animal withcomplete tumor regression highlighted by a moderate macrophageinfiltratein the non-neoplastic tissue and the CD11b stain also highlighted thezone of debris and admixed inflammation (FIG. 61 —Slide D).Immunohistochemical staining for CD68 (marker of histiocytes)highlighted a moderate macrophage infiltrate. No TLSs were noted in anyof the three animals.

Intratumoral NanoDoce® 2 Cycles:

Two of the three animals (750-254 and 748-827) in this group containedresidual viable invasive carcinoma. When measured on the H&E stainedslide this was significantly smaller in size (3 mm and 0.9 mm in maximumcross-sectional dimension on the slide respectively) compared to thecontrol, IT vehicle and IV docetaxel groups (range of 9-15 mm with mostof these being closer to 15 mm in maximum cross-sectional dimension onthe slide). In both IT NanoDoce® cases with residual carcinoma, therewas extensive geographic tumor cell necrosis surrounding the small fociof residual viable invasive carcinoma (FIG. 61 —Slides G, H and I).Higher power examination of H&E stained and keratin stained sectionsfrom the smaller of these residual tumors showed a progressivetransition from viable carcinoma cells to necrotic carcinoma cells withthe latter being identified by labeling of their residual degeneratingkeratin intermediate filaments with the pancytokeratin immunostain (FIG.61 —Slides I and L). In both animals with residual carcinoma,immunohistochemical staining for CD11b highlighted a moderate immunecell infiltrate in the necrotic tissue. Immunohistochemical staining forCD68 (marker of histiocytes) highlighted a moderate macrophageinfiltrate within the necrotic areas in both cases. The third case(748-826) in this group showed extensive geographic tumor cellcoagulative necrosis with no residual viable invasive carcinoma noted onH&E or keratin-stained sections. Immunohistochemical staining for CD11bhighlighted a patchy moderate immune cell infiltrate.Immunohistochemical staining for CD68 (marker of macrophages)highlighted a patchy moderate macrophage infiltrate. No TLSs were notedin any of the three animals.

Intratumoral NanoDoce® 3 Cycles:

Both cases in this group (748-797 and 748-822) showed extensivegeographic tumor cell coagulative necrosis with no residual viableinvasive carcinoma noted on H&E or keratin-stained sections (FIG. 61—Slides M-O). Immunohistochemical staining for CD11b highlighted amoderate and marked immune cell infiltrate in the necrotic tissue in thetwo animals respectively. Immunohistochemical staining for CD68 (markerof histiocytes) highlighted a mild and marked macrophage infiltratewithin the necrotic areas in these two cases, respectively. No TLSs werenoted in either of these two animals. Note: Animals in NanoDoce®treatment groups had tumors with white “calcified” areas, likelyresulting from nanoparticle deposits that remained within the tumor.

Additional Observations: (No Figures)

IT NanoDoce® Vehicle Group: The two intratumoral vehicle casesdemonstrated similar findings at the morphologic and immunohistochemicallevel and both essentially had an identical morphologic andimmunohistochemical appearance to that seen in the control group.IV Docetaxel: The two intratumoral IV docetaxel cases demonstratedsimilar findings at the morphologic and immunohistochemical level andboth essentially had an identical morphologic and immunohistochemicalappearance to that seen in the control and IT vehicle groups.Tumor volume results for Paclitaxel Group and Docetaxel Group:

Animals were weighed, and tumor length and width were measured withdigital calipers three times weekly for 58 days and at the time ofnecropsy. Tumor volume (V) was calculated as follows: V(mm³)=((L*W²))/2

where L is the largest diameter and W is the width (in mm) of the tumor.Study Log® was employed for statistical analysis of tumor volume andbody weight.

The mean tumor volume results for the Paclitaxel groups are shown inFIG. 62 . Mean tumor volume results for the Docetaxel groups are shownin FIG. 63 . As can be seen in the figures, IT NanoPac® and IT NanoDoce®both effectively treated the tumors.

Regarding the tumor volume results for the Docetaxel groups, the firstmeasurable tumors for both males and females were observed at 2 dayspost-inoculation.

Non-treated and vehicle control-treated tumors continued to growthroughout treatment, with final volumes in female rats ranging from5656 mm³ to less than 10,000 mm3. IV docetaxel treatment resulted inpartial tumor growth inhibition compared to vehicle control.

NanoDoce® delivered IT was the most efficacious treatment compared tovehicle and all other treatments. In most animals, the tumors treatedwith one, two or three cycles of IT NanoDoce® appeared to havecompletely regressed with only necrotic tissue remaining at the originaltumor site.

Upon necropsy, animals in NanoDoce® treatment groups had tumors withwhite “calcified” areas, likely resulting from nanoparticle depositsthat remained within the tumor.

Docetaxel Group Results:

Docetaxel Concentration in Tissue: Tumor tissue concentrations ofdocetaxel were determined by LC-MS/MS analysis using its deuteratedanalogue docetaxel-d₉ as the internal standard. Using a methodpreviously developed by Frontage, concentrations of docetaxel wereobtained from calibration curves constructed by plotting the peak arearatios (analyte to internal standard) versus analyte concentration usinglinear regression with a weighting of 1/x². The nominal concentrationrange was 1.00-2,000 ng/g for docetaxel in tumor tissue. A calibrationcurve, prepared in rat control tumor tissue homogenate, was analyzed atthe beginning and the end of each analytical run. Two sets of qualitycontrol (QC) samples were prepared at four concentration levels (low,mid-1, mid-2 and high) and were used to ensure reliability of the assay.

Thirty-eight days following the last of three weekly cycles of IVdocetaxel (5-2.5 mg/kg), one of four animals evaluated had a detectable(LOQ=1.00 ng/g) docetaxel level of 21.8 ng/g. All three animals in theNanoDoce® QWX1 group had detectable docetaxel levels ranging from 659ng/g to 1.4×10⁵ ng/g 51 days post-treatment. Two animals from theNanoDoce® QWX2 group were evaluated and had levels of 2.49 and 5.26 μg/g44 days post-treatment. As there was no tumor available for analysis inthe NanoDoce® QWX3 group, no analysis was performed.

Animals: Throughout the treatment period, animals across all groupsdisplayed relatively normal weight gain compared to non-treated animalsand vehicle control with a few exceptions. One animal that receivedNanoDoce® QWX1 had weight loss at treatment day 9. Despitesupplementation she continued to lose weight and was subsequentlyeuthanized on treatment day 16 due to reaching weight loss endpoints.One animal that received NanoDoce® QWX3 lost a significant amount ofweight, reaching endpoints at treatment day 39 despite supplementation.

Other observations include ulceration and apparent peripheralneuropathy. All animals that received NanoDoce® exhibited ulcerations orlesions on the surface of the tumor. These lesions were described as“scabs”, areas of dry, rigid tissue. In most cases the wounds remainedintact. A single animal that received NanoDoce® QWX3 showed hindlimbweakness and limited mobility on day 35 post-treatment. Withintervention, the weakness stabilized enough for the animal to remain inthe study. However, the animal was euthanized on day 49 due toulcerations that covered >50% of the tumor surface.

The ranges of sizes (the maximum cross-sectional dimension of the viablecarcinoma as measured in millimeters on the slide) of the residualtumors in the six groups are shown in Table 27.

TABLE 27 No viable <1 1-5 6-10 >10 Group # tumor mm mm mm mm Control 2 2IT vehicle 2 1 1 IV docetaxel 2 2 IT NanoDoce ® 1 3 1 2 IT NanoDoce ® 23 1 1 1 IT NanoDoce ® 3 2 2

A condensation of the data in Table 27 which directly compares the sizeof the residual carcinoma nodules in the three non-NanoDoce® groups (6animals in total) with the three NanoDoce® groups (8 animals in total)is shown in Table 28.

TABLE 28 No viable <1 1-5 6-10 >10 Groups # tumor mm mm mm mmnon-NanoDoce ® 6 1 5 IT NanoDoce ® 8 4 1 3

Five of the six non-NanoDoce® animals, including both IV docetaxelanimals, had residual viable carcinoma nodules that measured greaterthan 10 mm, and most of these were closer to 15 mm. The remainingnon-NanoDoce® animal had viable carcinoma measuring 9 mm in maximumdimension. By contrast, half (4/8) of the animals treated with ITNanoDoce® had no residual viable carcinoma on the slide to measure. Allthe remaining 4 animals in the IT NanoDoce® group that had residualviable carcinoma had a viable carcinoma nodule that measured 5 mm orless in maximum dimension on the slide. This included one case where thetumor measured 0.9 mm, and this was not evident when the tumor wasmeasured grossly prior to microscopic examination.

A comparison of the three IT NanoDoce® groups with respect to percentageof cases with no residual invasive carcinoma and the size of residualviable carcinoma nodules is shown in Table 29.

TABLE 29 No % of cases with no viable <1 1-5 Size of viable residualGroups # tumor mm mm nodules (mm) carcinoma IT Nano 1 3 1 2   4, 5 33%IT Nano 2 3 1 1 1 0.9, 3 33% IT Nano 3 2 2 N/A 100% 

IT NanoDoce® 1 and 2 cycle groups both had 1/3 of cases with no residualviable carcinoma while the IT NanoDoce® 3 cycle group had 2/2 of caseswith no residual viable invasive carcinoma. Amongst the cases withresidual viable carcinoma, progressive increase in the number of cyclesof IT NanoDoce® was associated with a decrease in the size of theresidual viable carcinoma nodule. Specifically, the residual viablecarcinoma nodule measured 4 mm and 5 mm in the IT NanoDoce® 1 cyclegroup and in the IT NanoDoce® 2 cycle group the nodules measured 0.9 mmand 3 mm. There was no residual viable carcinoma to measure in the twocases in the IT NanoDoce® 3 cycle group.

A percentage of tissue showing necrosis is shown in Table 30.

TABLE 30 Groups # 100% >90% 50-90% 5-50% <5% Control 2 2 IT vehicle 2 2IV Doce 2 2 IT Nano 1 3 1  2* IT Nano 2 3 1 1 1 IT Nano 3 2 2

All six animals in the non-NanoDoce® group showed <5% necrosis. Thisconsisted of focal small discrete foci of necrosis in the tumor thatwere small, occupying <5% of the tumor area, and they were withincentral portions of the tumor nodule, suggesting that these may besecondary to hypoxemia due to tumor outgrowing its blood supply. Four ofthe eight NanoDoce® animals showed complete necrosis of tumor. Two ofthe four NanoDoce® animals with residual carcinoma showed extensivenecrosis in the surrounding tissue (>50% of tissue). *The two remainingNanoDoce® animals with residual carcinoma did not have sufficientsurrounding tissue for definitive assessment of necrosis although one ofthese did contain a focal rim of necrosis that represented <5% of thesubmitted tissue area.

The lymphohistiocytic infiltrate density based on assessment of WE andimmunohistochemical staining with CD11b, graded semi quantitatively isshown in Table 31.

TABLE 31 Groups # Mild Moderate Marked Control 2 2 IT vehicle 2 2 IVDoce 2 2 IT Nano 1 3 2 1 IT Nano 2 3 3 IT Nano 3 2 1 1

All six animals in the non-NanoDoce® groups contained a mild immune cellinfiltrate and this was present in the peritumoral non-neoplastic stromawithout any significant immune cell infiltrate within the tumor. Bycontrast, 7 of the 8 animals in the NanoDoce® groups contained amoderate immune cell infiltrate while the remaining animal had a markedimmune cell infiltrate. This correlated with the increased amount ofnecrosis in the IT NanoDoce®-treated animals. Discussion of DocetaxelGroup Results:

A review was conducted on the morphologic and immunohistochemicalfeatures of a subset of 14 female rats from the renal cell carcinomastudy aimed to assess the efficacy of intratumoral NanoDoce® (the totalstudy contained 30 animals). The current subset of 14 animals includedtwo control animals, two animals given intratumoral vehicle, two animalstreated with intravenous docetaxel (3 cycles) and eight animals treatedwith intratumoral NanoDoce®. The NanoDoce® group was separated intothree groups based on the number of administered cycles: group 1 (1cycle; 3 animals), group 2 (2 cycles; 3 animals), and group 3 (3 cycles;2 animals).

The main feature that differed amongst the various groups was thepresence and degree of tumor regression. In all animals in theintratumoral NanoDoce® groups, tumor regression was prominent, while inall animals in the other groups, tumor regression was absent.

All six animals in the non-NanoDoce® group (i.e. control, IT vehicle andIV docetaxel groups) had residual viable tumor. This consisted of adense nodule of invasive carcinoma that was sharply demarcated from thesurrounding normal stromal tissue. The carcinoma cells were closelypacked together and while there were scattered discrete foci ofcoagulative tumor cell necrosis present, these were small in size,overall occupied <5% of the tumor area in each of the six animals, andwere within central portions of the tumor nodule. These observationssuggest that these areas of necrosis may be secondary to hypoxemia dueto tumor outgrowing its blood supply (Table 10). Keratin staining showedstrong, sensitive and specific staining of tumor cells. The maximumdimension of the viable tumor nodule, as measured on the stained slides,ranged from 9-15 mm in these six animals and in many this was closer to15 mm (Tables 27 and 28). This tumor size on the slide corresponded tothe tumor measurement taken at the time of gross dissection.

By contrast, four of the eight animals treated with intratumoralNanoDoce® had no residual viable carcinoma as determined by assessmentof H&E and keratin-stained sections (complete response). Of theremaining four animals, the residual viable tumor, as measured on thestained slide, was markedly smaller than that seen in the non-NanoDoce®group (Tables 27 and 28). Specifically, the size of the residual viabletumor nodules in these four animals treated with IT NanoDoce® rangedfrom 0.9 mm to 5 mm in maximum dimension (Table 29). In three of theseanimals, the tumor size measured on the slide correlated with the tumorsize measurement taken at the time of gross dissection. In the remaininganimal with a 0.9 mm focus of invasive carcinoma, this was presentamongst extensive necrosis and was not evident at the time of grossdissection.

In six of the eight NanoDoce® animals, there was extensive tumor cellcoagulative necrosis that extended into adjacent necrotic skeletalmuscle and fibrous tissue in some animals. In addition, focally withinthe necrotic areas there was keratin-staining of necrotic, non-viable,ghost tumor cell outlines, consistent with labelling of degeneratingkeratin intermediate filaments from dead tumor cells. This furthersupported that these areas previously contained viable carcinoma thathad completely responded to therapy. In the slides from the tworemaining animals there was very limited surrounding tissue forassessment of necrosis although one of these did contain a focalperipheral rim of necrosis in one area.

Within the non-NanoDoce® group there was a uniformly mild immune cellinfiltrate, and this was seen primarily in the non-neoplastic tissuesurrounding the tumor. There was no significant intratumoral immune cellinfiltrate. By contrast, the intratumoral NanoDoce® group included twocases with a mild immune cell infiltrate, five cases with a moderateimmune cell infiltrate and a single case with a marked immune cellinfiltrate within the necrotic areas (Table 31). Like the non-NanoDoce®group, there was no significant intratumoral lymphoid infiltration.There were no diagnostic tertiary lymphoid structures (TLSs) seen in anyof the 14 animals in this study group.

In summary, this review was limited to 14 female animals out of a studythat contained 30 female animals; however, a striking difference in thetype and degree of tumor response to therapy was noted when theintratumoral NanoDoce® group was compared to the non-NanoDoce® groups.None of the six non-NanoDoce® group animals showed any overt evidence oftumor regression and all had residual viable carcinoma nodules thatranged in size from 9-15 mm as measured on the slide. However, all eightanimals in the intratumoral NanoDoce® group showed evidence of tumorresponse and extensive necrosis was noted in all six of the animals thathad sufficient surrounding tissue for assessment. The tumor responseincluded compete regression in half of this group (4/8), as demonstratedby lack of definitive residual viable carcinoma on examination of H&Eand keratin-stained sections, while the remaining four animals containeda focal small residual viable carcinoma nodule, the largest of whichmeasured 5 mm and the smallest of which measured 0.9 mm. In two of thesefour animals with residual carcinoma, there was sufficient surroundingtissue present on the slides for assessment and this showed extensivenecrosis. Similarly, the degree of immune cell infiltrate in thenon-NanoDoce® group was mild while it ranged from mild to marked in theNanoDoce® group suggesting an association with the degree of tumorresponse and resultant necrotic debris.

When the three IT NanoDoce® groups were compared with each other, it wasnoted that as the animals received increasing cycles of intratumoralNanoDoce® therapy they showed a greater degree of tumor response. Inparticular, of the 3 animals in the group receiving 1 cycle of ITNanoDoce®, one of three animals showed complete response while theremaining two animals had residual nodules measuring 4 and 5 mm. Of thethree animals in the group receiving 2 cycles of IT NanoDoce®, oneshowed complete response while the remaining two animals had residualnodules measuring 0.9 and 3 mm. Finally, both animals in the groupreceiving 3 cycles of IT NanoDoce® showed complete response to therapy(two of two evaluated) (Table 29).

In conclusion, all eight animals with renal cell carcinoma in this studythat were treated with intratumoral NanoDoce® exhibited a notablehistological response which included a 50% rate of complete tumorregression as well as a marked decrease in residual tumor size in theremaining four animals. Associated extensive necrosis and increasedimmune response was noted in the NanoDoce® groups and focal areas ofkeratin-labelling of a nuclear, non-viable, ghost tumor cell outlines inthe necrotic areas further supported that these areas previouslycontained viable carcinoma that had completely responded to therapy. Bycontrast, there was no such tumor regression in thenon-NanoDoce®-treated groups. Furthermore, increasing cycles ofintratumoral NanoDoce® from 1 to 3 cycles resulted in a progressivelygreater degree of tumor regression and a progressively higher rate ofcomplete regression within the IT NanoDoce® cohort.

Example 16—Combination Therapy Study—Phase II Study of the Pre-Treatmentof Subjects with Recurrent or Metastatic Non-Small Cell Lung Cancer withInhaled NanoPac® Prior to Treatment with Pembrolizumab Summary

In this Phase II study, subjects with recurrent or metastatic non-smallcell lung cancer scheduled for treatment by immunotherapy drugpembrolizumab will receive NanoPac® inhalation therapy via nebulizer 2days prior to receiving pembrolizumab treatment.

This study will consist of two cohorts, 1) pembrolizumab monotherapy,and 2) inhaled NanoPac® prior to treatment with pembrolizumabcombination therapy.

Pembrolizumab monotherapy will be administered via IV at 74 mg/m2 over30 minutes every 3 weeks, Inhaled NanoPac® at a concentration of 7.08mg/m2 will be administered using a jet nebulizer two days prior topembrolizumab therapy.

Description of Study Agent:

Test Article: The test article used for inhalation exposure is shownbelow:

NanoPac®:

Identity: NanoPac® (sterile nanoparticulate Paclitaxel)Description: Novel dry powder formulation of Paclitaxel delivered as 306mg/vial

Vehicle

The vehicles used for preparation of NanoPac® formulations are shownbelow:

1% Polysorbate 80 Solution

Identity: Sterile 1% Polysorbate 80 in 0.9% sodium chloride forinjectionDescription: Clear liquid

Normal Saline Diluent

Identity: Sterile 0.9% sodium chloride for injection, USPDescription: Clear liquid

The test article, NanoPac® (paclitaxel particles, vehicle and diluent),will be prepared for inhalation into the lung at a concentration of 5mg/kg.

Population

Men and women ≥18 years of age with an ECOG performance status of 0 or 1

Histologically confirmed recurrent or metastatic NSCLC that has eitherprogressed during or after platinum based chemotherapy.

Received at least 1 platinum based chemotherapy regimen.

Primary Objective

Determine overall response rate (ORR) by independent review andintegrated medical oncologist disease assessment based on ResponseEvaluation Criteria in non-small cell tumors (RECIST) v.1.1 ofpembrolizumab monotherapy and the combination of NanoPac® andpembrolizumab in subjects with recurrent or metastatic non-small celllung cancer.

Secondary Objectives

Estimation of duration of response, estimation of progression-freesurvival (PFS) and overall survival (OS).

Determination of best overall response and response rate perimmune-mediated response criteria (irRC) by investigators and by anindependent review committee.

Results of the study will demonstrate that the combination therapy willhave greater efficacy than the systemic immunotherapeutic agent therapyalone (monotherapy) as evidenced by the overall response rate,progression-free survival and overall survival.

Example 16—Intratumoral Injection of Paclitaxel Particles inGlioblastomas in Mice Brains

In this study, the efficacy of paclitaxel particles againstglioblastomas (GB) was assessed. Nude mouse brains were injected with GBcells to establish primary tumors, which were injected after two weekswith paclitaxel particles (Nanotax). We monitored survival benefitagainst a control group that received only saline injections and acontrol group that has received Taxol™ (formulated in cremophor)injections. We delivered a dose of 100 mg/m2 to the growing tumor bydirect injection. Table 32 below shows four different tumor sizes andthe corresponding dose of paclitaxel particles of the invention,assuming a spherical shape for the tumor. As a control experiment Taxol™formulated in cremophor and diluted in saline to the correctconcentration was used.

TABLE 32 Tumor Tumor Radius Surface ng of Nanotax Dilution (mm) (mm²)per injection* Factor ** 0.5 3.1 314.2 50 1 12.6 1256.6 13 1.5 28.32827.4 6 2 50.3 5026.5 3 *at a dose of 100 mg/m² ** 5 μl injection;Nanotax stock solution: 3,150 ng/μl

At the highest dose of 5 μg of Paclitaxel per injection no toxicity wasobserved.

Injected mice were kept alive for 8 to 9 days, after which noneurological symptoms were observed. After 9 days, the mice weresacrificed and the brains harvested; the brains were dissected along theinjection path and analyzed. Neither the paclitaxel particle group northe Taxol™ group showed necrosis or lesions. Brain slices were usedwithout further preparation to be analyzed with three different imagingtechnologies to create a composite image (data not shown):

-   -   (a) 2nd harmonic generation (SHG): Images appear in blue, mostly        collagen and vessels and paclitaxel particles.    -   (b) Two-photon excitation fluorescence (TPEF): Images appear in        green, mostly reactive cells, microglia, macrophages, some        neuronal bodies.    -   (c) Coherent Anti-Stokes Raman Scattering (CARS): Images appear        in red, tuned to —CH2 vibrations to look at lipids—mostly to        myelin in the CNS, but also lipid droplet containing cells        called foam cells will give a positive signal. Degenerating        cells and macrophages with lipid vacuoles will also show up.

Due to the non-linear optical properties of the paclitaxel particlecrystals, the crystals can be seen directly with the second harmonicgeneration imaging technology. Clusters of paclitaxel particles wereclearly visible at the injection site (i.e.: accumulated within thetumor) 9 days after injection in a mouse that was injected with 5 μg ofpaclitaxel particles and showed no neurological symptoms (data notshown).

Example 17—Pharmacokinetics and Tissue Distribution of PaclitaxelParticles Following Intraperitoneal Injection in Mice

Purpose: This study was conducted to determine the level of absorptionof paclitaxel from the peritoneal cavity into the systemic circulationfollowing intraperitoneal delivery of a paclitaxel particle suspension.Tissue distribution of paclitaxel from the paclitaxel particlesuspension following intraperitoneal administration was also evaluated.

Experimental Details: Female C57BL6 mice were inoculated with ID8ovarian cancer cells and tumors were allowed to grow for 45 days. Thesemice were treated with paclitaxel particle suspension (36 mg/kg) in 0.9%saline via intraperitoneal administration in a total volume of 4 mL.Plasma and peritoneal fluid samples were collected at Time zero(pre-dose), 1, 6, 24 and 48 hours (at least four mice per time point)and paclitaxel in the plasma and peritoneal fluid was measured byLC-MS/MS. In addition, tissue samples were collected at Time zero(pre-dose), 1, 6, 24 and 48 hours post intraperitoneal administration ofpaclitaxel particles. Inguinal lymph nodes, peritoneal wall, ovary,liver, heart, lung, brain and tumor tissue samples from miceadministered paclitaxel particles were analyzed by LC-MS/MS.

Results and Significance: The results of the paclitaxel levels in theplasma, peritoneal fluid and organ tissue samples are shown in thefollowing table. Plasma paclitaxel remained at a very low level over the48-hour period. The paclitaxel levels in the peritoneal fluid were muchhigher and demonstrated a substantial amount of variation. The limit ofquantitation of the analytical method for paclitaxel was 0.01 μg/gm. Thelevels of paclitaxel in tissues inside the peritoneal cavity wereconsistently high as demonstrated by the results for the ovarian tumors,ovary, inguinal lymph nodes and peritoneal membrane. In contrast, thepaclitaxel levels in tissues outside the peritoneal cavity wereconsistently lower as shown in the liver, heart, lung and brain tissues.These same results are shown in Table 33.

This data is significant because of the unexpectedly high levels ofpaclitaxel in the tissues that are in contact with the peritoneal fluid(ovarian tumors, ovary, inguinal lymph nodes and peritoneal membrane),and little paclitaxel to tissues not in contact with the peritonealfluid. Based on these and other studies, the release of paclitaxel fromthe paclitaxel particles continues for several weeks and would beexpected to provide a continuously high amount of paclitaxel, whichwould mean that the paclitaxel would accumulate in very high levels ifinjected directly into the tumor.

TABLE 33 Summary Levels of Paclitaxel in chemotherapeuticparticles-treated Mouse Tissue, Plasma and Peritoneal Fluid (values inμg/g) (4 animals) Time Tumor Ovary Lymph Membrane Liver Heart Plasma IPFluid Lung Brain (hours) (μg/g) (μg/g) (μg/g) (μg/g) (μg/g) (μg/g)(μg/ml) (μg/ml) (μg/g) (μg/g) 0 0.0 0.00 0.00 0 0 0 0.0 0.0 0.00 0 0.00.00 0.00 0 0 0 0.0 0.0 0.00 0 0.0 0.00 0.00 0 0 0 0.0 0.0 0.00 0 0.00.00 0.00 0 0 0 0.0 0.0 0.00 0 1 458.6 500.00 190.80 107.23 7.0 0 0.549.0 1.97 0.04 180.1 263.64 199.28 31.42 6.7 0 0.0 1.0 BQL 0.13 135.3498.00 122.90 9.38 3.1 0 0.0 0.7 2.78 BQL 158.1 1193.75 296.36 133.47 90 0.2 24.6 0.78 0.36 6 126.2 1068.97 486.87 64.8 48.8 0 0.0 1.2 1.180.11 240.0 816.33 648.15 91.38 46.6 0 0.4 40.4 1.65 BQL 701.2 751.0548.86 132.35 27.0 0 0.0 1.8 0.75 BQL 89.7 211.20 143.33 97.41 14.3 0 0.04.2 1.56 0.08 24 81.3 502.70 90.14 27.09 41.3 0 0.0 1.5 5.22 0.29 204.51706.42 86.83 65.31 41.9 2.77 0.2 24.0 0.92 0.08 241.2 335.58 238.64109.96 50.3 0 0.0 5.1 0.83 1.36 208.8 603.64 254.00 124.41 29.7 3 BQ BQ1.10 0.82 48 294.0 529.94 124.17 270.95 116.4 0 0.1 12.0 BQL 0.05 4001389.83 1795.45 79.5 44.2 0 0.0 1.5 BQL 0.06 505.4 711.48 81.94 80.3376.6 0 0.0 5.2 BQL 0.18 174.9 1272.11 224.88 218.24 34.0 0 0.2 28.6 BQLBQL

Example 18—Pilot Toxicity and Efficacy Testing of NanoPac® inCombination with Pembrolizumab Staggered Dosing in Hu-CD34-NSG™-SGM3Bearing TM00302

Project Summary: Female hu-CD34 NSG™ SGM3 mice (NOD.Cg-PrkdcscidIl2rgtm1Wjl Tg(CMV-IL3,CSF2,KITLG)1Eav/MloySzJ) that have been engraftedwith human CD34+ cells and have >25% human CD45+ cells in the peripheralblood 10 weeks post engraftment or later will be used for the study.Cohorts of hu-CD34 NSG™ SGM3 mice engrafted with CD34+ cells from two orthree donors (depending on the phase below) will be used. The mice willbe ear notched for identification and housed in individually andventilated polysulfone cages with HEPA filtered air at a density of upto 5 mice per cage. Cages will be changed every two weeks. The animalroom is lighted entirely with artificial fluorescent lighting, with acontrolled 12 h light/dark cycle (6 am to 6 μm light). The normaltemperature and relative humidity ranges in the animal rooms are 20-26°C. and 30-70%, respectively. The animal rooms will be set to have up to15 air exchanges per hour. Filtered tap water, acidified to a pH of 2.5to 3.0, and standard lab chow will be provided ad libitum.

-   -   1. hu-CD34 NSG™ mice from one CD34 donor will be implanted        subcutaneously in the right flank with tumor fragments from the        TM00302 PDX model.    -   2. Body weights and clinical observations will be recorded 1× to        2×weekly.    -   3. Digital caliper measurements will be initiated to determine        tumor volume 1× to 2×weekly when tumors become palpable.    -   4. Mice will be randomized based on tumor volumes according to        Table 34 when the tumor volumes reach ˜100-200 mm3 (Study Day-1        or Study Day 0).    -   5. Mice will be dosed according to Table 34 starting on Study        Day 0.    -   Note: IT injections will be performed by fan technique. The fan        injection technique will consist of 2-5 compound deposition        sites from a single epidermal puncture. The amount of compound        deposition sites will be dictated by the size of the tumor.        Tumors 100-200 mm³ will receive 2 depositions, 200-400 will        receive 3, 400-600 will receive 4, and 600+ will receive 5.    -   6. Body weights, clinical observations and digital caliper        measurements will be recorded 2×weekly post dose initiation.    -   7. Animals that reach a body condition score of ≤2, a body        weight loss of ≥20% or a tumor volume >2000 mm³ will be        euthanized before study terminus. Animals with ulcerated tumors        will also be euthanized before study terminus.    -   Note: Tissues will not be collected from animals that are found        dead.    -   8. On Study Day 35, all animals will be euthanized by CO2        asphyxiation and tissues collected. Tumors will be collected and        sent for flow cytometry characterization.

TABLE 34 Tumor Growth Curves Dose Dosing Group N* Compound (mg/kg)Route^(#) Dosing Frequency 1 5 Vehicle NA IT 1x/wk for 3 wks startingSD0 Vehicle NA IV BIWx4 starting SD0 2 5 NanoPac ® 30 IT 1x/wk for 3 wksstarting SD0 Pembrolizumab 5 IV BIWx4 starting SD0 3 5 NanoPac ® 30 IT1x/wk for 3 wks starting SD0 Pembrolizumab 5 IV BIWx4 starting SD3 StudyIncludes # Mouse PDX Study Data Tissue Mice Type/ID Models DurationCollection Collection 15 Hu- TM00302 5 Weeks Caliper 15 Tumors (FreshCD34_SGM3 Measurements, in media) 013062 Body weight 15 Whole Blood andClinical terminal (Fresh Obs. 2x/wk in media) *1 donor will be used.^(#)IT injections will not exceed 50 ul.

Results will demonstrate that treatment with the combination of NanoPac®and Pembrolizumab will have greater efficacy than the treatment withvehicle as evidenced by:

-   -   (a) greater reduction of tumor size with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with vehicle, or    -   (b) greater reduction in tumor growth with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with vehicle, or    -   (c) one or more incidences of tumor elimination with the animals        treated with the combination of NanoPac® and Pembrolizumab        versus no incidences of tumor elimination with the animals        treated with vehicle.

Example 19—Growth Curve Analysis of PDX Model TM00176 Followed byEfficacy testing of NanoPac® Alone and in Combination with Pembrolizumabin Hu-CD34-NSG™-SGM3

Project Summary:

The study will be broken into 2 phases.

-   -   Phase 1: Preliminary drug toxicity and efficacy of staggered        dosing in hu-SGM3 mice bearing TM00302. (n=10)    -   Phase 2: Efficacy study in Hu-CD34-NSG™-SGM3 mice (n=100) Female        hu-CD34 NSG™ SGM3 mice (NOD.Cg-Prkdcscid Il2rgtm1Wjl        Tg(CMV-IL3,CSF2,KITLG)1Eav/MloySzJ) that have been engrafted        with human CD34+ cells and have >25% human CD45+ cells in the        peripheral blood 10 weeks post engraftment or later will be used        for the study. Cohorts of hu-CD34 NSG™ SGM3 mice engrafted with        CD34+ cells from two or three donors (depending on the phase        below) will be used.        The mice will be ear notched for identification and housed in        individually and ventilated polysulfone cages with HEPA filtered        air at a density of up to 5 mice per cage. Cages will be changed        every two weeks. The animal room is lighted entirely with        artificial fluorescent lighting, with a controlled 12 h        light/dark cycle (6 am to 6 μm light). The normal temperature        and relative humidity ranges in the animal rooms are 20-26° C.        and 30-70%, respectively. The animal rooms will be set to have        up to 15 air exchanges per hour. Filtered tap water, acidified        to a pH of 2.5 to 3.0, and standard lab chow will be provided ad        libitum.

Phase 1:

-   -   1. hu-CD34 NSG™ mice from one CD34 donor will be implanted        subcutaneously in the right flank with tumor fragments from the        TM00302 PDX model.    -   2. Body weights and clinical observations will be recorded 1× to        2×weekly.    -   3. Digital caliper measurements will be initiated to determine        tumor volume 1× to 2×weekly when tumors become palpable.    -   4. Mice will be randomized based on tumor volumes according to        Table 35 when the tumor volumes reach ˜100-200 mm3 (Study Day-1        or Study Day 0).    -   5. Mice will be dosed according to Table 35 starting on Study        Day 0.    -   Note: IT injections will be performed by fan technique. The fan        injection technique will consist of 2-5 compound deposition        sites from a single epidermal puncture. The amount of compound        deposition sites will be dictated by the size of the tumor.        Tumors 100-200 mm3 will receive 2 depositions, 200-400 will        receive 3, 400-600 will receive 4, and 600+ will receive 5.    -   6. Body weights, clinical observations and digital caliper        measurements will be recorded 2×weekly post dose initiation.    -   7. Animals that reach a body condition score of ≤2, a body        weight loss of ≥20% or a tumor volume >2000 mm3 will be        euthanized before study terminus. Animals with ulcerated tumors        will also be euthanized before study terminus.    -   Note: Tissues will not be collected from animals that are found        dead.    -   8. On Study Day 35, all animals will be euthanized by CO2        asphyxiation and tissues collected.        Tumors will be collected and separated into fragments. 1        fragment will be fixed in 10% neutral buffered formalin (NBF)        and sent for paraffin embedding (FFPE). FFPE blocks will be        shipped to the Sponsor or third party as requested. 1 fragment        will be flash frozen and shipped to the Sponsor or third party        as requested.

TABLE 35 Tumor Growth Curves Dose Dosing Group N* Compound (mg/kg)Route^(#) Dosing Frequency 1 5 NanoPac ® 30 IT 1x/wk for 3 wks startingSD0 Pembrolizumab 5 IV BIWx4 starting SD0 2 5 NanoPac ® 30 IT 1x/wk for3 wks starting SD0 Pembrolizumab 5 IV BIWx4 starting SD3 Study Includes# Mouse PDX Study Data Tissue Mice Type/ID Models Duration CollectionCollection 10 Hu- TM00302 5 Weeks Caliper 10 Tumors (FACS) CD34_SGM3Measurements, 10 Whole Blood 013062 Body weight terminal (FACS) andClinical Obs. 2x/wk *1 donor will be used. ^(#)IT injections will notexceed 50 ul.

Phase 2:

-   -   1. hu-CD34 NSG™ mice from three CD34 donors will be implanted        subcutaneously in the right flank with tumor fragments from a        PDX model to be determined.    -   2. Body weights and clinical observations will be recorded 1× to        2×weekly.    -   3. Digital caliper measurements will be initiated to determine        tumor volume 1× to 2×weekly when tumors become palpable.    -   4. Mice will be randomized based on tumor volumes according to        Table 36 when the tumor volumes reach ˜100-200 mm3 (Study Day-1        or Study Day 0). In addition, efforts will be made to distribute        hu-CD34 NSG™ SGM3 mice from different donors evenly across study        groups. Each group may be enrolled multiple times to reach the        desired group size.    -   5. Mice will be dosed according to Table 36 starting on Study        Day 0.    -   6. Note: IT injections will be performed by fan technique. The        fan injection technique will consist of 2-5 compound deposition        sites from a single epidermal puncture. The amount of compound        deposition sites will be dictated by the size of the tumor.        Tumors 100-200 mm3 will receive 2 depositions, 200-400 will        receive 3, 400-600 will receive 4, and 600+ will receive 5.    -   7. Body weights, clinical observations and digital caliper        measurements will be recorded 3×weekly post dose initiation.    -   8. Animals that reach a body condition score of ≤2, a body        weight loss of ≥20% or a tumor volume >2000 mm3 will be        euthanized before study terminus. Animals with ulcerated tumors        will also be euthanized before study terminus.    -   Note: Tissues will not be collected from animals that are found        dead.    -   9. On Study Day 41 or 42, pictures will be taken of each tumor.    -   10. On Study Day 42, all animals will be euthanized by CO2        asphyxiation and tissues collected.        Tumors will be collected, weighted, and separated into        fragments.        1 fragment will be placed in media and shipped to Flow Contract        Site Laboratory (FCS) for flow cytometry analysis. The following        markers will be examined: CD45, CD3, CD4, CD8, 7AAD.        1 fragment will be fixed in 10% neutral buffered formalin (NBF)        and sent for paraffin embedding (FFPE). FFPE blocks will be        shipped to the Sponsor or third party as requested.        1 fragment will be flash frozen and shipped to the Sponsor or        third party as requested.        Note: If the tumor is too small to cut into two pieces (≤400        mm3), the single piece of tumor will be processed according to        the Sponsor's direction.        Note: in the case that mice must come down on a Friday, Saturday        or Sunday the samples cannot be processed for flow cytometry and        will instead be split into 2 fragments, one for FFPE and the        other flash frozen.        Whole blood will be collected at the end of study.        ˜100 μL whole blood will be shipped to Flow Contract Site        Laboratory (FCS) for flow cytometry analysis. The following        markers will be examined: CD45, CD3, CD4, CD8, 7AAD The        remaining blood will be processed to serum, flash frozen, and        shipped to the Sponsor or third party as requested.        Note: in the case that mice must come down on a Friday, Saturday        or Sunday the samples cannot be processed for flow cytometry and        entire samples will be processed to serum, flash frozen, and        shipped to the Sponsor or third party as requested.

TABLE 36 Efficacy Experiment Design Dose Dosing Dosing Group N*Compound^(#) (mg/kg) Route** Frequency 1 25 N/A Vehicle N/A IT 1x/wk forControl 3 wks N/A Vehicle N/A IV BIWx4 Control 2 25 Pembrolizumab 5 IV1x/wk for 3 wks 3 25 NanoPac ® 30 IT 1x/wk for 3 wks 4 25 NanoPac ® 30IT 1x/wk for 3 wks Pembrolizumab 5 IV BIWx4 Study Includes # Mouse PDXStudy Data Tissue Mice Type/ID Models Duration Collection Collection 100Hu- TBD 5 Weeks Caliper 100 Tumors (1 CD34_SGM3 TM00176 Measurements,fragments FACS, 013062 or Body weight 1 fragment FFPE, TM00302 andClinical 1 fragment Obs. 3x/wk flash frozen Photos of 100 Whole Bloodtumors at (FACS, and takedown Frozen Serum) Tumor weight 100 Bone Marrowon takedown from Femurs (FACS and Frozen) *5 donors will be used. Thefinal number of animals from each donor enrolled per group will dependon the availability of animals with tumor volumes that meet theenrollment criteria at the time of experiment. ^(#)Group 4 Nanopacdosing will occur 72 hours +/− 4 hours after the Pembrolizumab dosing.**IT injections will not exceed 50 ul.

The results of the study will demonstrate that treatment with thecombination of NanoPac® and Pembrolizumab will have greater efficacythan the treatment with Pembrolizumab alone and/or the treatment withNanoPac® alone (monotherapy) as evidenced by at least one of thefollowing:

-   -   (a) greater reduction of tumor size with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with Pembrolizumab alone, or    -   (b) greater reduction in tumor growth with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with Pembrolizumab alone, or    -   (c) one or more incidences of tumor elimination with the animals        treated with the combination of NanoPac® and Pembrolizumab        versus no incidences of tumor elimination with the animals        treated with Pembrolizumab alone, or    -   (d) greater reduction of tumor size with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with NanoPac® alone, or    -   (e) greater reduction in tumor growth with the animals treated        with the combination of NanoPac® and Pembrolizumab than with the        animals treated with NanoPac® alone, or    -   (f) one or more incidences of tumor elimination with the animals        treated with the combination of NanoPac® and Pembrolizumab        versus no incidences of tumor elimination with the animals        treated with NanoPac® alone, and/or    -   the results of the study will demonstrate a synergistic effect        on efficacy with the combination of NanoPac® and Pembrolizumab        as evidenced by at least one of the following:    -   (g) the reduction of tumor size of the animals treated with the        combination of NanoPac® and Pembrolizumab is greater than the        sum of the reductions of the tumor size of the animals treated        with Pembrolizumab alone plus those treated with NanoPac® alone,        or    -   (h) the reduction of tumor growth of the animals treated with        the combination of NanoPac® and Pembrolizumab is greater than        the sum of the reductions of the tumor growth of the animals        treated with Pembrolizumab alone plus those treated with        NanoPac® alone, or    -   (i) the number of incidences of tumor elimination of the animals        treated with the combination of NanoPac® and Pembrolizumab is        greater than the sum of the number of incidences of tumor        elimination of the animals treated with Pembrolizumab alone plus        those treated with NanoPac® alone.

LITERATURE REFERENCES

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1.-133. (canceled)
 134. A method of treating cancer in a subject, themethod comprising: (a) administering a first composition comprisingtaxane particles to a subject having a tumor, wherein the taxaneparticles comprise paclitaxel particles, docetaxel particles,cabazitaxel particles, or combinations thereof, wherein the taxaneparticles comprise at least 95% of the taxane, and wherein the taxaneparticles have a specific surface area (SSA) of at least 18 m²/g, and(b) systemically administering a second composition comprising animmunotherapeutic agent to the subject, wherein the immunotherapeuticagent comprises an immune checkpoint inhibitor, thereby treating thecancer, wherein the taxane particles have a mean particle size (number)of from 0.1 microns to 5 microns, and wherein steps (a) and (b) can beconducted in any order or at the same time.
 135. The method of claim134, wherein the tumor is a malignant tumor.
 136. The method of claim134, wherein the tumor comprises a lung tumor, sarcoma, a carcinoma, alymphoma, a breast tumor, a prostate tumor, a head and neck tumor, aglioblastoma, a bladder tumor, a pancreatic tumor, a liver tumor, anovarian tumor, a colorectal tumor, a skin tumor, an intraperitonealorgan tumor, a cutaneous metastasis, a lymphoid, and/or agastrointestinal tumor.
 137. The method of claim 134, wherein the immunecheckpoint inhibitor is selected from the group consisting ofipilimumab, pembrolizumab and nivolumab.
 138. The method of claim 134,wherein the taxane particles have a mean particle size (number) of from0.1 microns to 1.5 microns.
 139. The method of claim 134, wherein thetaxane particles are paclitaxel particles.
 140. The method of claim 139,wherein the paclitaxel particles have a bulk density (not-tapped) of0.05 g/cm³ to 0.15 g/cm³.
 141. The method of claim 134, wherein thetaxane particles are docetaxel particles.
 142. The method of claim 141,wherein the docetaxel particles have a bulk density (not-tapped) of 0.05g/cm³ to 0.15 g/cm³.
 143. The method of claim 134, wherein theadministering comprises topical administration, pulmonaryadministration, or intraperitoneal injection of the first composition tothe subject.
 144. The method of claim 134 wherein the concentration ofthe taxane particles in the first composition is between about 1 mg/mland about 40 mg/ml, or between about 6 mg/mL and about 20 mg/mL. 145.The method of claim 134, wherein the first composition does not containa protein.
 146. The method of claim 134, wherein the second compositioncomprises a pharmaceutically acceptable carrier.
 147. The method ofclaim 134, wherein the systemic administration is intravenous (IV)injection or oral delivery.